AB 443: Optometry: scope of practice.
- Session Year: 2017-2018
- House: Assembly
- Latest Version Date: 2017-10-07
The Optometry Practice Act provides for the licensure and regulation of the practice of optometry by the State Board of Optometry, which is within the Department of Consumer Affairs. That act provides that 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 doing certain things, including, but not limited to, the examination of the human eye or eyes. Existing law makes a violation of the act punishable as a crime.
This bill would revise the scope of the practice of optometry by, among other things, providing that the practice of optometry includes the provision of habilitative optometric services.
Existing law authorizes an optometrist certified to use therapeutic pharmaceutical agents to diagnose and treat specified conditions and perform certain procedures.
This bill would additionally authorize an optometrist who is certified to use therapeutic pharmaceutical agents, among other things, to perform skin testing to diagnose ocular allergies, to perform intravenous injection for the purpose of performing ocular angiography under specified circumstances, and to treat and diagnose hypotrichosis and blepharitis. The bill would authorize an optometrist certified to use therapeutic pharmaceutical agents to administer immunizations if the optometrist meets certain requirements, including that the optometrist is certified in basic life support.
Existing law requires an optometrist to consult with and refer a patient to an ophthalmologist or a physician and surgeon in certain circumstances, including if a patient has a recurrent case of peripheral corneal inflammatory keratitis within one year of the initial occurrence.
This bill would instead require an optometrist to 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 optometrists scope of practice. The bill would require all consultations, referrals, and notifications be documented in the patient record. By changing the definition of an existing crime, this bill would impose a state-mandated local program.
Existing law requires all moneys collected pursuant to the act, except fine and penalty money, to be deposited in the Optometry Fund and continuously appropriated to the board to carry out the act.
This bill would require an applicant for a certificate to administer immunizations to pay a fee not to exceed $50. Because this bill would increase those moneys deposited in a continuously appropriated fund, it would make an appropriation.
This bill would incorporate additional changes to Section 3057 of the Business and Professions Code proposed by AB 1708 to be operative only if this bill and AB 1708 are enacted and this bill is enacted last.
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 Optometry Practice Act provides for the licensure and regulation of the practice of optometry by the State Board of Optometry, which is within the Department of Consumer Affairs. That act provides that 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 doing certain things, including, but not limited to, the examination of the human eye or eyes. Existing law makes a violation of the act punishable as a crime.
This bill would revise the scope of the practice of optometry by, among other things, providing that the practice of optometry includes the provision of habilitative optometric services.
Existing law authorizes an optometrist certified to use therapeutic pharmaceutical agents to diagnose and treat specified conditions and perform certain procedures.
This bill would additionally authorize an optometrist who is certified to use therapeutic pharmaceutical agents, among other things, to perform skin testing to diagnose ocular allergies, to perform intravenous injection for the purpose of performing ocular angiography under specified circumstances, and to treat and diagnose hypotrichosis and blepharitis. The bill would authorize an optometrist certified to use therapeutic pharmaceutical agents to administer immunizations if the optometrist meets certain requirements, including that the optometrist is certified in basic life support.
Existing law requires an optometrist to consult with and refer a patient to an ophthalmologist or a physician and surgeon in certain circumstances, including if a patient has a recurrent case of peripheral corneal inflammatory keratitis within one year of the initial occurrence.
This bill would instead require an optometrist to 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 optometrists scope of practice. The bill would require all consultations, referrals, and notifications be documented in the patient record. By changing the definition of an existing crime, this bill would impose a state-mandated local program.
Existing law requires all moneys collected pursuant to the act, except fine and penalty money, to be deposited in the Optometry Fund and continuously appropriated to the board to carry out the act.
This bill would require an applicant for a certificate to administer immunizations to pay a fee not to exceed $50. Because this bill would increase those moneys deposited in a continuously appropriated fund, it would make an appropriation.
This bill would incorporate additional changes to Section 3057 of the Business and Professions Code proposed by AB 1708 to be operative only if this bill and AB 1708 are enacted and this bill is enacted last.
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 Optometry Practice Act provides for the licensure and regulation of the practice of optometry by the State Board of Optometry, which is within the Department of Consumer Affairs. That act provides that 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 doing certain things, including, but not limited to, the examination of the human eye or eyes. Existing law makes a violation of the act punishable as a crime.
This bill would revise the scope of the practice of optometry by, among other things, providing that the practice of optometry includes the provision of habilitative optometric services.
Existing law authorizes an optometrist certified to use therapeutic pharmaceutical agents to diagnose and treat specified conditions and perform certain procedures.
TheThis bill would additionally authorize an optometrist who is certified to use therapeutic pharmaceutical agents to, agents, among other things, to perform skin testing to diagnose ocular allergies allergies, to perform intravenous injection for the purpose of performing ocular angiography under specified circumstances, and to treat and diagnose hypotrichosis and blepharitis. The bill would authorize an optometrist certified to use therapeutic pharmaceutical agents to administer immunizations if the optometrist meets certain requirements, including that the optometrist is certified in basic life support.
Existing law requires an optometrist to consult with and refer a patient to an ophthalmologist or a physician and surgeon in certain circumstances, including if a patient has a recurrent case of peripheral corneal inflammatory keratitis within one year of the initial occurrence.
This bill would instead require an optometrist to 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 optometrists scope of practice. The bill would require all consultations, referrals, and notifications be documented in the patient record. By changing the definition of an existing crime, this bill would impose a state-mandated local program.
Existing law requires all moneys collected pursuant to the act, except fine and penalty money, to be deposited in the Optometry Fund and continuously appropriated to the board to carry out the act.
This bill would require an applicant for a certificate to administer immunizations to pay a fee not to exceed $50. Because this bill would increase those moneys deposited in a continuously appropriated fund, it would make an appropriation.
This bill would incorporate additional changes to Section 3057 of the Business and Professions Code proposed by AB 1708 to be operative only if this bill and AB 1708 are enacted and this bill is enacted last.
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 Optometry Practice Act provides for the licensure and regulation of the practice of optometry by the State Board of Optometry, which is within the Department of Consumer Affairs. That act provides that 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 doing certain things, including, but not limited to, the examination of the human eye or eyes. Existing law makes a violation of the act punishable as a crime.
This bill would revise the scope of the practice of optometry by, among other things, providing that the practice of optometry includes the provision of habilitative optometric services.
Existing law authorizes an optometrist who meets certain requirements, including, but not limited to, completing a preceptorship of 65 hours and a minimum of 100 hours of directed and accredited education in ocular and systemic diseases, to use therapeutic pharmaceutical agents. Existing law authorizes an optometrist certified to use therapeutic pharmaceutical agents to diagnose and treat specified conditions and perform certain procedures.This bill would delete the requirement of 100 hours of directed and accredited study and would instead require, except as specified, an optometrist to satisfactorily complete and pass an examination in a didactic course of no more than 80 classroom hours in the diagnosis, pharmacological, and other treatment and management of ocular disease provided at an accredited school of optometry in the state or an accredited ophthalmology residency program in the state and 20 hours of self-directed education. The bill would require the preceptorship of 65 hours to be completed in either an ophthalmologists office or an optometric clinic and would require the preceptor to be an ophthalmologist licensed by and in good standing with the Medical Board of California.The bill would additionally authorize an optometrist who is certified to use therapeutic pharmaceutical agents to, among other things, perform skin testing to diagnose ocular allergies and to treat and diagnose hypotrichosis and blepharitis. The bill would authorize an optometrist certified to use therapeutic pharmaceutical agents to administer immunizations if the optometrist meets certain requirements, including that the optometrist is certified in basic life support.
Existing law requires an optometrist to consult with and refer a patient to an ophthalmologist or a physician and surgeon in certain circumstances, including if a patient has a recurrent case of peripheral corneal inflammatory keratitis within one year of the initial occurrence.
This bill would instead require an optometrist to 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 optometrists scope of practice. The bill would require all consultations, referrals, and notifications be documented in the patient record. By changing the definition of an existing crime, this bill would impose a state-mandated local program.
Existing law requires all moneys collected pursuant to the act, except fine and penalty money, to be deposited in the Optometry Fund and continuously appropriated to the board to carry out the act.
This bill would require an applicant for a certificate to administer immunizations to pay a fee not to exceed $50. Because this bill would increase those moneys deposited in a continuously appropriated fund, it would make an appropriation.
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 Optometry Practice Act provides for the licensure and regulation of the practice of optometry by the State Board of Optometry, which is within the Department of Consumer Affairs. That act authorizes the board, before it sets aside the revocation or suspension of an optometrist license, to require the applicant to pass the regular examination given to applicants for an optometrist license. That act provides that 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 doing certain things, including, but not limited to, the examination of the human eye or eyes. Existing law makes a violation of the act punishable as a crime.
This bill would require the board, if it exercises its authority to require an applicant to take the regular examination, to notify the applicant of the timeframe to take and pass the examination and to provide the applicant with a minimum 30 days notice before an available examination that the applicant is required to take the examination.This bill would revise the scope of the practice of optometry by, among other things, providing that the practice of optometry includes the provision of habilitative optometric services.
Existing law authorizes an optometrist who meets certain requirements, including, but not limited to, completing a preceptorship of 65 hours and a minimum of 100 hours of directed and accredited education in ocular and systemic diseases, to use therapeutic pharmaceutical agents. Existing law authorizes an optometrist certified to use therapeutic pharmaceutical agents to diagnose and treat specified conditions and perform certain procedures.
This bill would delete the requirement of 100 hours of directed and accredited study and would instead require, except as specified, an optometrist to satisfactorily complete and pass an examination in a didactic course of no more than 80 classroom hours in the diagnosis, pharmacological, and other treatment and management of ocular disease provided at an accredited school of optometry in the state or an accredited ophthalmology residency program in the state and 20 hours of self-directed education. The bill would require the preceptorship of 65 hours to be completed in either an ophthalmologists office or an optometric clinic and would require the preceptor to be an ophthalmologist licensed by and in good standing with the Medical Board of California.
The bill would additionally authorize an optometrist who is certified to use therapeutic pharmaceutical agents to, among other things, perform skin testing to diagnose ocular allergies and to treat and diagnose hypotrichosis and blepharitis. The bill would authorize an optometrist certified to use therapeutic pharmaceutical agents to administer immunizations if the optometrist meets certain requirements, including that the optometrist is certified in basic life support.
Existing law requires an optometrist to consult with and refer a patient to an ophthalmologist or a physician and surgeon in certain circumstances, including if a patient has a recurrent case of peripheral corneal inflammatory keratitis within one year of the initial occurrence.
This bill would instead require an optometrist to 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 optometrists scope of practice. By changing the definition of an existing crime, this bill would impose a state-mandated local program.
Existing law requires all moneys collected pursuant to the act, except fine and penalty money, to be deposited in the Optometry Fund and continuously appropriated to the board to carry out the act.
This bill would require an applicant for a certificate to administer immunizations to pay a fee not to exceed $50. Because this bill would increase those moneys deposited in a continuously appropriated fund, it would make an appropriation.
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 Optometry Practice Act provides for the licensure and regulation of the practice of optometry by the State Board of Optometry, which is within the Department of Consumer Affairs. That act authorizes the board, before it sets aside the revocation or suspension of an optometrist license, to require the applicant to pass the regular examination given to applicants for an optometrist license.
This bill would require the board, if it exercises its authority to require an applicant to take the regular examination, to notify the applicant of the timeframe to take and pass the examination and to provide the applicant with a minimum 30 days notice before an available examination that the applicant is required to take the examination.
(a)As used in this chapter, laboratory director means any person who is any of the following:
(1)A duly licensed physician and surgeon.
(2)Only for purposes of a clinical laboratory test or examination classified as waived, is any of the following:
(A)A duly licensed clinical laboratory scientist.
(B)A duly licensed limited clinical laboratory scientist.
(C)A duly licensed naturopathic doctor.
(D)A duly licensed optometrist serving as the director of a laboratory that only performs clinical laboratory tests authorized in paragraph (10) of subdivision (d) of Section 3041.
(3)Licensed to direct a clinical laboratory under this chapter.
(b)(1)A person defined in paragraph (1) or (3) of subdivision (a) who is identified as the CLIA laboratory director of a laboratory that performs clinical laboratory tests classified as moderate or high complexity shall also meet the laboratory director qualifications under CLIA for the type and complexity of tests being offered by the laboratory.
(2)As used in this subdivision, CLIA laboratory director means the person identified as the laboratory director on the CLIA certificate issued to the laboratory by the federal Centers for Medicare and Medicaid Services (CMS).
(c)The laboratory director, if qualified under CLIA, may perform the duties of the technical consultant, technical supervisor, clinical consultant, general supervisor, and testing personnel, or delegate these responsibilities to persons qualified under CLIA. If the laboratory director reapportions performance of those responsibilities or duties, he or she shall remain responsible for ensuring that all those duties and responsibilities are properly performed.
(d)(1)The laboratory director is responsible for the overall operation and administration of the clinical laboratory, including administering the technical and scientific operation of a clinical laboratory, the selection and supervision of procedures, the reporting of results, and active participation in its operations to the extent necessary to ensure compliance with this act and CLIA. He or she shall be responsible for the proper performance of all laboratory work of all subordinates and shall employ a sufficient number of laboratory personnel with the appropriate education and either experience or training to provide appropriate consultation, properly supervise and accurately perform tests, and report test results in accordance with the personnel qualifications, duties, and responsibilities described in CLIA and this chapter.
(2)Where a point-of-care laboratory testing device is utilized and provides results for more than one analyte, the testing personnel may perform and report the results of all tests ordered for each analyte for which he or she has been found by the laboratory director to be competent to perform and report.
(e)As part of the overall operation and administration, the laboratory director of a registered laboratory shall document the adequacy of the qualifications (educational background, training, and experience) of the personnel directing and supervising the laboratory and performing the laboratory test procedures and examinations. In determining the adequacy of qualifications, the laboratory director shall comply with any regulations adopted by the department that specify the minimum qualifications for personnel, in addition to any CLIA requirements relative to the education or training of personnel.
(f)As part of the overall operation and administration, the laboratory director of a licensed laboratory shall do all of the following:
(1)Ensure that all personnel, prior to testing biological specimens, have the appropriate education and experience, receive the appropriate training for the type and complexity of the services offered, and have demonstrated that they can perform all testing operations reliably to provide and report accurate results. In determining the adequacy of qualifications, the laboratory director shall comply with any regulations adopted by the department that specify the minimum qualifications for, and the type of procedures that may be performed by, personnel in addition to any CLIA requirements relative to the education or training of personnel. Any regulations adopted pursuant to this section that specify the type of procedure that may be performed by testing personnel shall be based on the skills, knowledge, and tasks required to perform the type of procedure in question.
(2)Ensure that policies and procedures are established for monitoring individuals who conduct preanalytical, analytical, and postanalytical phases of testing to ensure that they are competent and maintain their competency to process biological specimens, perform test procedures, and report test results promptly and proficiently, and, whenever necessary, identify needs for remedial training or continuing education to improve skills.
(3)Specify in writing the responsibilities and duties of each individual engaged in the performance of the preanalytic, analytic, and postanalytic phases of clinical laboratory tests or examinations, including which clinical laboratory tests or examinations the individual is authorized to perform, whether supervision is required for the individual to perform specimen processing, test performance, or results reporting, and whether consultant, supervisor, or director review is required prior to the individual reporting patient test results.
(g)The competency and performance of staff of a licensed laboratory shall be evaluated and documented by the laboratory director, or by a person who qualifies as a technical consultant or a technical supervisor under CLIA depending on the type and complexity of tests being offered by the laboratory.
(1)The procedures for evaluating the competency of the staff shall include, but are not limited to, all of the following:
(A)Direct observations of routine patient test performance, including patient preparation, if applicable, and specimen handling, processing, and testing.
(B)Monitoring the recording and reporting of test results.
(C)Review of intermediate test results or worksheets, quality control records, proficiency testing results, and preventive maintenance records.
(D)Direct observation of performance of instrument maintenance and function checks.
(E)Assessment of test performance through testing previously analyzed specimens, internal blind testing samples, or external proficiency testing samples.
(F)Assessment of problem solving skills.
(2)Evaluation and documentation of staff competency and performance shall occur at least semiannually during the first year an individual tests biological specimens. Thereafter, evaluations shall be performed at least annually unless test methodology or instrumentation changes, in which case, prior to reporting patient test results, the individuals performance shall be reevaluated to include the use of the new test methodology or instrumentation.
(h)The laboratory director of each clinical laboratory of an acute care hospital shall be a physician and surgeon who is a qualified pathologist, except as follows:
(1)If a qualified pathologist is not available, a physician and surgeon or a clinical laboratory bioanalyst qualified as a laboratory director under subdivision (a) may direct the laboratory. However, a qualified pathologist shall be available for consultation at suitable intervals to ensure high-quality service.
(2)If there are two or more clinical laboratories of an acute care hospital, those additional clinical laboratories that are limited to the performance of blood gas analysis, blood electrolyte analysis, or both, may be directed by a physician and surgeon qualified as a laboratory director under subdivision (a), irrespective of whether a pathologist is available.
As used in this subdivision, a qualified pathologist is a physician and surgeon certified or eligible for certification in clinical or anatomical pathology by the American Board of Pathology or the American Osteopathic Board of Pathology.
(i)Subdivision (h) does not apply to any director of a clinical laboratory of an acute care hospital acting in that capacity on or before January 1, 1988.
(j)A laboratory director may serve as the director of up to the maximum number of laboratories stipulated by CLIA, as defined under Section 1202.5.
SEC. 2.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.
(D)Traumatic or recurrent conjunctival or corneal abrasions and erosions.
(E)Nonmalignant ocular surface disease and dry eye disease.
(F)Ocular pain, nonsurgical in cause except when comanaged with the treating physician and surgeon, associated with conditions optometrists are authorized to treat.
(G)Hypotrichosis and blepharitis.
(H)Pursuant to subdivision (e), 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 (d).
(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 or prescribe, including for rational off-label purposes, all of the following therapeutic pharmaceutical agents:
(1)Topical pharmaceutical agents for the examination of the human eye or eyes for any disease or pathological condition, including, but not limited to, 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 patients condition worsens 21 days after diagnosis.
(4)Topical and oral anti-inflammatories.
(5)Topical antibiotic agents.
(6)Topical hyperosmotics.
(7)Topical and oral antiglaucoma agents pursuant to the certification process defined in subdivision (e).
(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.
(12)Topical and oral antiviral medication for the medical treatment of herpes simplex viral keratitis, herpes simplex viral conjunctivitis, periocular herpes simplex viral dermatitis, varicella zoster viral keratitis, varicella zoster viral conjunctivitis, and periocular varicella zoster viral dermatitis.
(13)Oral analgesics that are not controlled substances.
(14)Codeine with compounds, hydrocodone with compounds, and tramadol 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.
(15)Additional therapeutic pharmaceutical agents pursuant to subdivision (f).
(d)An optometrist who is certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 may also perform all of the following procedures:
(1)Corneal scraping with cultures.
(2)Debridement of corneal epithelia.
(3)Mechanical epilation.
(4)Collection of blood by skin puncture or 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 the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA) (42 U.S.C. Sec. 263a; Public Law 100-578) 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 use or prescription of diagnostic or 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. 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.
(15)Intravenous injection for the purpose of performing ocular angiography at the direction of an ophthalmologist as part of an active treatment plan in a setting where a physician and surgeon is immediately available.
(16)Skin testing to diagnose ocular allergies, limited to the superficial layer of the skin.
(17)Use of any noninvasive medical device or technology authorized pursuant to subdivision (f).
(e)An optometrist certified pursuant to Section 3041.3 shall be certified 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 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 who are not described in paragraph (2) or (3), submission of proof of satisfactory completion of the requirements for certification established by the board under Chapter 352 of the Statutes of 2008.
(f)(1)Any topical or oral therapeutic pharmaceutical agent, which is not a controlled substance, or noninvasive medical device or technology that is not expressly authorized for use or prescription by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 shall be deemed to be authorized if it has received a United States Food and Drug Administration approved indication for the diagnosis or treatment of a condition authorized by this chapter. A licensee shall successfully complete any clinical training imposed by a related manufacturer prior to using any of those therapeutic pharmaceutical agents or noninvasive medical devices or technologies.
(2)Any other topical or oral therapeutic pharmaceutical agent, which is not a controlled substance, or noninvasive medical device or technology that is not expressly authorized for use or prescription by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 and does not meet the requirements in paragraph (1) shall be deemed authorized if approved by the board through regulation for the rational treatment of a condition authorized by this chapter. Any regulation under this paragraph shall require a licensee to successfully complete an appropriate amount of clinical training to qualify to use each topical or oral therapeutic pharmaceutical agent or noninvasive medical device or technology approved by the board pursuant to this paragraph.
(3)This subdivision shall not be construed to authorize any of the following:
(A)Any therapeutic pharmaceutical agent, medical device, or technology involving cutting, altering, or otherwise infiltrating human tissue by any means.
(B)A clinical laboratory test or imaging study not authorized by paragraphs (1) to (16), inclusive, of subdivision (d).
(C)Treatment of any disease or condition that could not be treated by an optometrist before January 1, 2018.
(g)(1)An optometrist certified pursuant to Section 3014.3 shall be certified for the administration of immunizations after the optometrist meets all of the following requirements:
(A)Completes an immunization training program endorsed by the federal Centers for Disease Control and Prevention (CDC) that, at a minimum, includes hands-on injection technique, clinical evaluation of indications and contradications of vaccines, and the recognition and treatment of emergency reactions to vaccines, and maintains that training.
(B)Is certified in basic life support.
(C)Complies with all state and federal recordkeeping and reporting requirements, including providing documentation to the patients primary care provided and entering information in the appropriate immunization registry designated by the immunization branch of the State Department of Public Health.
(D)Applies for an immunization certificate on a board-approved form.
(2)For the purposes of this section, immunization means the administration of immunizations for influenza, herpes zoster virus, and pneumococcus in compliance with individual Advisory Committee on Immunization Practices (ACIP) vaccine recommendations published by the CDC for persons 18 years of age or older.
(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)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 paragraphs (1) to (15), inclusive, of subdivision (d). This subdivision does not limit an optometrists authority to utilize diagnostic laser and ultrasound technology within his or her scope of practice.
(j)An optometrist licensed under this chapter is subject to the provisions of Section 2290.5 for purposes of practicing telehealth.
(k)For purposes of this chapter, glaucoma means either of the following:
(1)All primary open-angle glaucoma.
(2)Exfoliation and pigmentary glaucoma.
(3)(A)Steroid induced glaucoma.
(B)If an optometrist treats a patient for steroid induced glaucoma the optometrist shall promptly notify the prescriber of the steroid medication if the prescriber did not refer the patient to the optometrist for treatment.
(l)For purposes of this chapter, adnexa means ocular adnexa.
(m)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. 3.Section 3041.1 of the Business and Professions Code is amended to read:3041.1.An optometrist 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 optometristss scope of practice. Consultations, referrals, and notifications required by this section shall be documented in the patient record.
SEC. 4.Section 3041.2 of the Business and Professions Code is amended to read:3041.2.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 educational and examination requirements shall be a condition for the issuance of an original optometrist license or certifications pursuant to this chapter.
SEC. 5.Section 3041.3 of the Business and Professions Code is amended to read: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) and (d) 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 therapeutic pharmaceutical agents (TPA) certification 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)Completes a preceptorship of no less than 65 hours, during a period of not less than two months nor more than one year, with either a TPA-certified optometrist in good standing or a physician and surgeon board-certified in ophthalmology in good standing. The training received during the preceptorship shall be on the diagnosis, treatment, and management of ocular and systemic disease. The preceptor shall certify completion of the preceptorship using a form approved by the board. 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 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.
(2)Successfully completes a minimum of 100 hours of directed and accredited education in ocular and systemic diseases within two years prior to meeting the requirements of paragraph (1).
(3)Passes the National Board of Examiners in Optometrys 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.
(c)The board shall grant a therapeutic pharmaceutical agents certification 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 passes all sections of the National Board of Examiners in Optometrys national board examination or its equivalent, as determined by the State Board of Optometry.
(d)The board shall grant a therapeutic pharmaceutical agents certification 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 granted a therapeutic pharmaceutical agents certification.
(1)In order to obtain a therapeutic pharmaceutical agents certification, 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 therapeutic pharmaceutical agents certification, 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 therapeutic pharmaceutical agents certification, 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 therapeutic pharmaceutical agents certification, 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 optometrists education or training under this subdivision.
SEC. 6.Section 3056 of the Business and Professions Code is amended to read:3056.(a)The board may issue a license to practice optometry to a person who meets all of the following qualifications:
(1)Has a degree as a doctor of optometry issued by an accredited school or college of optometry.
(2)Is currently licensed in another state.
(3)Is currently a full-time faculty member of an accredited California school or college of optometry and has served in that capacity for a period of at least five continuous years.
(4)Has attained, at an accredited California school or college of optometry, the academic rank of professor, associate professor, or clinical professor, except that the status of adjunct or affiliated faculty member shall not be deemed sufficient.
(5)Has successfully passed the boards jurisprudence examination.
(6)Is in good standing, with no past or pending malpractice awards or judicial or administrative actions.
(7)Has met the minimum continuing education requirements set forth in Section 3059 for the current and preceding year.
(8)Has met the requirements of Section 3041.3 regarding the use of therapeutic pharmaceutical agents under subdivision (d) of Section 3041.
(9)Has never had his or her license to practice optometry revoked or suspended.
(10)(A)Is not subject to denial based on any of the grounds listed in Section 480.
(B)Is not currently required to register as a sex offender pursuant to Section 290 of the Penal Code.
(11)Pays an application fee in an amount equal to the application fee prescribed by the board pursuant to Section 3152.
(12)Files an application on a form prescribed by the board.
(b)Any license issued pursuant to this section shall expire as provided in Section 3146, and may be renewed as provided in this chapter, subject to the same conditions as other licenses issued under this chapter.
(c)The term in good standing, as used in this section, means that a person under this section:
(1)Is not currently under investigation nor has been charged with an offense for any act substantially related to the practice of optometry by any public agency, nor entered into any consent agreement or subject to an administrative decision that contains conditions placed by an agency upon a persons professional conduct or practice, including any voluntary surrender of license, nor been the subject of an adverse judgment resulting from the practice of optometry that the board determines constitutes evidence of a pattern of incompetence or negligence.
(2)Has no physical or mental impairment related to drugs or alcohol, and has not been found mentally incompetent by a physician so that the person is unable to undertake the practice of optometry in a manner consistent with the safety of a patient or the public.
SEC. 7.Section 3057 of the Business and Professions Code is amended to read:3057.(a)The board may issue a license to practice optometry to a person who meets all of the following requirements:
(1)Has a degree as a doctor of optometry issued by an accredited school or college of optometry.
(2)Has successfully passed the licensing examination for an optometric license in another state.
(3)Submits proof that he or she is licensed in good standing as of the date of application in every state where he or she holds a license, including compliance with continuing education requirements.
(4)Is not subject to disciplinary action as set forth in subdivision (h) of Section 3110. If the person has been subject to disciplinary action, the board shall review that action to determine if it presents sufficient evidence of a violation of this chapter to warrant the submission of additional information from the person or the denial of the application for licensure.
(5)Has furnished a signed release allowing the disclosure of information from the National Practitioner Database and, if applicable, the verification of registration status with the federal Drug Enforcement Administration. The board shall review this information to determine if it presents sufficient evidence of a violation of this chapter to warrant the submission of additional information from the person or the denial of the application for licensure.
(6)Has never had his or her license to practice optometry revoked or suspended in any state where the person holds a license.
(7)(A)Is not subject to denial of an application for licensure based on any of the grounds listed in Section 480.
(B)Is not currently required to register as a sex offender pursuant to Section 290 of the Penal Code.
(8)Has met the minimum continuing education requirements set forth in Section 3059 for the current and preceding year.
(9)Has met the certification requirements of Section 3041.3 to use therapeutic pharmaceutical agents under subdivision (d) of Section 3041.
(10)Submits any other information as specified by the board to the extent it is required for licensure by examination under this chapter.
(11)Files an application on a form prescribed by the board, with an acknowledgment by the person executed under penalty of perjury and automatic forfeiture of license, of the following:
(A)That the information provided by the person to the board is true and correct, to the best of his or her knowledge and belief.
(B)That the person has not been convicted of an offense involving conduct that would violate Section 810.
(12)Pays an application fee in an amount equal to the application fee prescribed pursuant to subdivision (a) of Section 3152.
(13)Has successfully passed the boards jurisprudence examination.
(b)If the board finds that the competency of a candidate for licensure pursuant to this section is in question, the board may require the passage of a written, practical, or clinical examination or completion of additional continuing education or coursework.
(c)In cases where the person establishes, to the boards satisfaction, that he or she has been displaced by a federally declared emergency and cannot relocate to his or her state of practice within a reasonable time without economic hardship, the board may reduce or waive the fees required by paragraph (12) of subdivision (a).
(d)Any license issued pursuant to this section shall expire as provided in Section 3146, and may be renewed as provided in this chapter, subject to the same conditions as other licenses issued under this chapter.
(e)The term in good standing, as used in this section, means that a person under this section:
(1)Is not currently under investigation nor has been charged with an offense for any act substantially related to the practice of optometry by any public agency, nor entered into any consent agreement or subject to an administrative decision that contains conditions placed by an agency upon a persons professional conduct or practice, including any voluntary surrender of license, nor been the subject of an adverse judgment resulting from the practice of optometry that the board determines constitutes evidence of a pattern of incompetence or negligence.
(2)Has no physical or mental impairment related to drugs or alcohol, and has not been found mentally incompetent by a licensed psychologist or licensed psychiatrist so that the person is unable to undertake the practice of optometry in a manner consistent with the safety of a patient or the public.
SEC. 7.5.Section 3057 of the Business and Professions Code is amended to read:3057.(a)The board may issue a license to practice optometry to a person who meets all of the following requirements:
(1)Has a degree as a doctor of optometry issued by an accredited school or college of optometry.
(2)Has successfully passed the licensing examination for an optometric license in another state.
(3)Submits proof that he or she is licensed in good standing as of the date of application in every state where he or she holds a license, including compliance with continuing education requirements.
(4)Is not subject to disciplinary action as set forth in subdivision (h) of Section 3110. If the person has been subject to disciplinary action, the board shall review that action to determine if it presents sufficient evidence of a violation of this chapter to warrant the submission of additional information from the person or the denial of the application for licensure.
(5)Has furnished a signed release allowing the disclosure of information from the National Practitioner Data Bank and, if applicable, the verification of registration status with the federal Drug Enforcement Administration. The board shall review this information to determine if it presents sufficient evidence of a violation of this chapter to warrant the submission of additional information from the person or the denial of the application for licensure.
(6)Has never had his or her license to practice optometry revoked or suspended in any state where the person holds a license. This paragraph shall become inoperative on July 1, 2018.
(7)(A)Is not subject to denial of an application for licensure based on any of the grounds listed in Section 480.
(B)Is not currently required to register as a sex offender pursuant to Section 290 of the Penal Code.
(8)Has met the minimum continuing education requirements set forth in Section 3059 for the current and preceding year.
(9)Has met the certification requirements of Section 3041.3 to use therapeutic pharmaceutical agents under subdivision (d) of Section 3041.
(10)Submits any other information as specified by the board to the extent it is required for licensure by examination under this chapter.
(11)Files an application on a form prescribed by the board, with an acknowledgment by the person executed under penalty of perjury and automatic forfeiture of license, of the following:
(A)That the information provided by the person to the board is true and correct, to the best of his or her knowledge and belief.
(B)That the person has not been convicted of an offense involving conduct that would violate Section 810.
(12)Pays an application fee in an amount equal to the application fee prescribed pursuant to subdivision (a) of Section 3152.
(13)Has successfully passed the boards jurisprudence examination.
(b)If the board finds that the competency of a candidate for licensure pursuant to this section is in question, the board may require the passage of a written, practical, or clinical examination or completion of additional continuing education or coursework.
(c)In cases where the person establishes, to the boards satisfaction, that he or she has been displaced by a federally declared emergency and cannot relocate to his or her state of practice within a reasonable time without economic hardship, the board may reduce or waive the fees required by paragraph (12) of subdivision (a).
(d)Any license issued pursuant to this section shall expire as provided in Section 3146, and may be renewed as provided in this chapter, subject to the same conditions as other licenses issued under this chapter.
(e)The term in good standing, as used in this section, means that a person under this section:
(1)Is not currently under investigation nor has been charged with an offense for any act substantially related to the practice of optometry by any public agency, nor entered into any consent agreement or subject to an administrative decision that contains conditions placed by an agency upon a persons professional conduct or practice, including any voluntary surrender of license, nor been the subject of an adverse judgment resulting from the practice of optometry that the board determines constitutes evidence of a pattern of incompetence or negligence.
(2)Has no physical or mental impairment related to drugs or alcohol, and has not been found mentally incompetent by a licensed psychologist or licensed psychiatrist so that the person is unable to undertake the practice of optometry in a manner consistent with the safety of a patient or the public.
SEC. 8.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 licensees 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 bloodborne 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 bloodborne pathogens in health care settings. As necessary, the board may consult with the Medical Board of California, the California Board of Podiatric Medicine, the Board of Registered Nursing, and the Board of Vocational Nursing and Psychiatric Technicians of the State of California, 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 patients 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 and surgeon if an examination of the eyes indicates a substantial likelihood of any pathology that requires the attention of that physician and surgeon.
SEC. 9.Section 3152 of the Business and Professions Code is amended to read:3152.The amounts of fees and penalties prescribed by this chapter shall be established by the board in amounts not greater than those specified in the following schedule:
(a)The fee for applicants applying for a license shall not exceed two hundred seventy-five dollars ($275).
(b)The fee for renewal of an optometric license shall not exceed five hundred dollars ($500).
(c)The annual fee for the renewal of a branch office license shall not exceed seventy-five dollars ($75).
(d)The fee for a branch office license shall not exceed seventy-five dollars ($75).
(e)The penalty for failure to pay the annual fee for renewal of a branch office license shall not exceed twenty-five dollars ($25).
(f)The fee for issuance of a license or upon change of name authorized by law of a person holding a license under this chapter shall not exceed twenty-five dollars ($25).
(g)The delinquency fee for renewal of an optometric license shall not exceed fifty dollars ($50).
(h)The application fee for a certificate to perform lacrimal irrigation and dilation shall not exceed fifty dollars ($50).
(i)The application fee for a certificate to treat glaucoma shall not exceed fifty dollars ($50).
(j)The fee for approval of a continuing education course shall not exceed one hundred dollars ($100).
(k)The fee for issuance of a statement of licensure shall not exceed forty dollars ($40).
(l)The fee for biennial renewal of a statement of licensure shall not exceed forty dollars ($40).
(m)The delinquency fee for renewal of a statement of licensure shall not exceed twenty dollars ($20).
(n)The application fee for a fictitious name permit shall not exceed fifty dollars ($50).
(o)The renewal fee for a fictitious name permit shall not exceed fifty dollars ($50).
(p)The delinquency fee for renewal of a fictitious name permit shall not exceed twenty-five dollars ($25).
(q)The fee for a retired license shall not exceed twenty-five dollars ($25).
(r)The fee for a retired license with volunteer designation shall not exceed fifty dollars ($50).
(s)The biennial renewal fee for a retired license with volunteer designation shall not exceed fifty dollars ($50).
(t)The application fee for a certificate to administer immunizations shall not exceed fifty dollars ($50).
SEC. 10.Section 7.5 of this bill incorporates amendments to Section 3057 of the Business and Professions Code proposed by both this bill and Assembly Bill 1708. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2018, (2) each bill amends Section 3057 of the Business and Professions Code, and (3) this bill is enacted after Assembly Bill 1708, in which case Section 7 of this bill shall not become operative.
SEC. 11.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
(a)As used in this chapter, laboratory director means any person who is any of the following:
(1)A duly licensed physician and surgeon.
(2)Only for purposes of a clinical laboratory test or examination classified as waived, is any of the following:
(A)A duly licensed clinical laboratory scientist.
(B)A duly licensed limited clinical laboratory scientist.
(C)A duly licensed naturopathic doctor.
(D)A duly licensed optometrist serving as the director of a laboratory that only performs clinical laboratory tests authorized in paragraph (10) of subdivision (d) of Section 3041.
(3)Licensed to direct a clinical laboratory under this chapter.
(b)(1)A person defined in paragraph (1) or (3) of subdivision (a) who is identified as the CLIA laboratory director of a laboratory that performs clinical laboratory tests classified as moderate or high complexity shall also meet the laboratory director qualifications under CLIA for the type and complexity of tests being offered by the laboratory.
(2)As used in this subdivision, CLIA laboratory director means the person identified as the laboratory director on the CLIA certificate issued to the laboratory by the federal Centers for Medicare and Medicaid Services (CMS).
(c)The laboratory director, if qualified under CLIA, may perform the duties of the technical consultant, technical supervisor, clinical consultant, general supervisor, and testing personnel, or delegate these responsibilities to persons qualified under CLIA. If the laboratory director reapportions performance of those responsibilities or duties, he or she shall remain responsible for ensuring that all those duties and responsibilities are properly performed.
(d)(1)The laboratory director is responsible for the overall operation and administration of the clinical laboratory, including administering the technical and scientific operation of a clinical laboratory, the selection and supervision of procedures, the reporting of results, and active participation in its operations to the extent necessary to ensure compliance with this act and CLIA. He or she shall be responsible for the proper performance of all laboratory work of all subordinates and shall employ a sufficient number of laboratory personnel with the appropriate education and either experience or training to provide appropriate consultation, properly supervise and accurately perform tests, and report test results in accordance with the personnel qualifications, duties, and responsibilities described in CLIA and this chapter.
(2)Where a point-of-care laboratory testing device is utilized and provides results for more than one analyte, the testing personnel may perform and report the results of all tests ordered for each analyte for which he or she has been found by the laboratory director to be competent to perform and report.
(e)As part of the overall operation and administration, the laboratory director of a registered laboratory shall document the adequacy of the qualifications (educational background, training, and experience) of the personnel directing and supervising the laboratory and performing the laboratory test procedures and examinations. In determining the adequacy of qualifications, the laboratory director shall comply with any regulations adopted by the department that specify the minimum qualifications for personnel, in addition to any CLIA requirements relative to the education or training of personnel.
(f)As part of the overall operation and administration, the laboratory director of a licensed laboratory shall do all of the following:
(1)Ensure that all personnel, prior to testing biological specimens, have the appropriate education and experience, receive the appropriate training for the type and complexity of the services offered, and have demonstrated that they can perform all testing operations reliably to provide and report accurate results. In determining the adequacy of qualifications, the laboratory director shall comply with any regulations adopted by the department that specify the minimum qualifications for, and the type of procedures that may be performed by, personnel in addition to any CLIA requirements relative to the education or training of personnel. Any regulations adopted pursuant to this section that specify the type of procedure that may be performed by testing personnel shall be based on the skills, knowledge, and tasks required to perform the type of procedure in question.
(2)Ensure that policies and procedures are established for monitoring individuals who conduct preanalytical, analytical, and postanalytical phases of testing to ensure that they are competent and maintain their competency to process biological specimens, perform test procedures, and report test results promptly and proficiently, and, whenever necessary, identify needs for remedial training or continuing education to improve skills.
(3)Specify in writing the responsibilities and duties of each individual engaged in the performance of the preanalytic, analytic, and postanalytic phases of clinical laboratory tests or examinations, including which clinical laboratory tests or examinations the individual is authorized to perform, whether supervision is required for the individual to perform specimen processing, test performance, or results reporting, and whether consultant, supervisor, or director review is required prior to the individual reporting patient test results.
(g)The competency and performance of staff of a licensed laboratory shall be evaluated and documented by the laboratory director, or by a person who qualifies as a technical consultant or a technical supervisor under CLIA depending on the type and complexity of tests being offered by the laboratory.
(1)The procedures for evaluating the competency of the staff shall include, but are not limited to, all of the following:
(A)Direct observations of routine patient test performance, including patient preparation, if applicable, and specimen handling, processing, and testing.
(B)Monitoring the recording and reporting of test results.
(C)Review of intermediate test results or worksheets, quality control records, proficiency testing results, and preventive maintenance records.
(D)Direct observation of performance of instrument maintenance and function checks.
(E)Assessment of test performance through testing previously analyzed specimens, internal blind testing samples, or external proficiency testing samples.
(F)Assessment of problem solving skills.
(2)Evaluation and documentation of staff competency and performance shall occur at least semiannually during the first year an individual tests biological specimens. Thereafter, evaluations shall be performed at least annually unless test methodology or instrumentation changes, in which case, prior to reporting patient test results, the individuals performance shall be reevaluated to include the use of the new test methodology or instrumentation.
(h)The laboratory director of each clinical laboratory of an acute care hospital shall be a physician and surgeon who is a qualified pathologist, except as follows:
(1)If a qualified pathologist is not available, a physician and surgeon or a clinical laboratory bioanalyst qualified as a laboratory director under subdivision (a) may direct the laboratory. However, a qualified pathologist shall be available for consultation at suitable intervals to ensure high-quality service.
(2)If there are two or more clinical laboratories of an acute care hospital, those additional clinical laboratories that are limited to the performance of blood gas analysis, blood electrolyte analysis, or both, may be directed by a physician and surgeon qualified as a laboratory director under subdivision (a), irrespective of whether a pathologist is available.
As used in this subdivision, a qualified pathologist is a physician and surgeon certified or eligible for certification in clinical or anatomical pathology by the American Board of Pathology or the American Osteopathic Board of Pathology.
(i)Subdivision (h) does not apply to any director of a clinical laboratory of an acute care hospital acting in that capacity on or before January 1, 1988.
(j)A laboratory director may serve as the director of up to the maximum number of laboratories stipulated by CLIA, as defined under Section 1202.5.
SEC. 2.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.
(D)Traumatic or recurrent conjunctival or corneal abrasions and erosions.
(E)Nonmalignant ocular surface disease and dry eye disease.
(F)Ocular pain, nonsurgical in cause except when comanaged with the treating physician and surgeon, associated with conditions optometrists are authorized to treat.
(G)Hypotrichosis and blepharitis.
(H)Pursuant to subdivision (e), 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 (d).
(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 or prescribe, including for rational off-label purposes, all of the following therapeutic pharmaceutical agents:
(1)Topical pharmaceutical agents for the examination of the human eye or eyes for any disease or pathological condition, including, but not limited to, 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 patients condition worsens 21 days after diagnosis.
(4)Topical and oral anti-inflammatories.
(5)Topical antibiotic agents.
(6)Topical hyperosmotics.
(7)Topical and oral antiglaucoma agents pursuant to the certification process defined in subdivision (e).
(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.
(12)Topical and oral antiviral medication for the medical treatment of herpes simplex viral keratitis, herpes simplex viral conjunctivitis, periocular herpes simplex viral dermatitis, varicella zoster viral keratitis, varicella zoster viral conjunctivitis, and periocular varicella zoster viral dermatitis.
(13)Oral analgesics that are not controlled substances.
(14)Codeine with compounds, hydrocodone with compounds, and tramadol 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.
(15)Additional therapeutic pharmaceutical agents pursuant to subdivision (f).
(d)An optometrist who is certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 may also perform all of the following procedures:
(1)Corneal scraping with cultures.
(2)Debridement of corneal epithelia.
(3)Mechanical epilation.
(4)Collection of blood by skin puncture or 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 the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA) (42 U.S.C. Sec. 263a; Public Law 100-578) 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 use or prescription of diagnostic or 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. 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.
(15)Intravenous injection for the purpose of performing ocular angiography at the direction of an ophthalmologist as part of an active treatment plan in a setting where a physician and surgeon is immediately available.
(16)Skin testing to diagnose ocular allergies, limited to the superficial layer of the skin.
(17)Use of any noninvasive medical device or technology authorized pursuant to subdivision (f).
(e)An optometrist certified pursuant to Section 3041.3 shall be certified 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 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 who are not described in paragraph (2) or (3), submission of proof of satisfactory completion of the requirements for certification established by the board under Chapter 352 of the Statutes of 2008.
(f)(1)Any topical or oral therapeutic pharmaceutical agent, which is not a controlled substance, or noninvasive medical device or technology that is not expressly authorized for use or prescription by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 shall be deemed to be authorized if it has received a United States Food and Drug Administration approved indication for the diagnosis or treatment of a condition authorized by this chapter. A licensee shall successfully complete any clinical training imposed by a related manufacturer prior to using any of those therapeutic pharmaceutical agents or noninvasive medical devices or technologies.
(2)Any other topical or oral therapeutic pharmaceutical agent, which is not a controlled substance, or noninvasive medical device or technology that is not expressly authorized for use or prescription by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 and does not meet the requirements in paragraph (1) shall be deemed authorized if approved by the board through regulation for the rational treatment of a condition authorized by this chapter. Any regulation under this paragraph shall require a licensee to successfully complete an appropriate amount of clinical training to qualify to use each topical or oral therapeutic pharmaceutical agent or noninvasive medical device or technology approved by the board pursuant to this paragraph.
(3)This subdivision shall not be construed to authorize any of the following:
(A)Any therapeutic pharmaceutical agent, medical device, or technology involving cutting, altering, or otherwise infiltrating human tissue by any means.
(B)A clinical laboratory test or imaging study not authorized by paragraphs (1) to (16), inclusive, of subdivision (d).
(C)Treatment of any disease or condition that could not be treated by an optometrist before January 1, 2018.
(g)(1)An optometrist certified pursuant to Section 3014.3 shall be certified for the administration of immunizations after the optometrist meets all of the following requirements:
(A)Completes an immunization training program endorsed by the federal Centers for Disease Control and Prevention (CDC) that, at a minimum, includes hands-on injection technique, clinical evaluation of indications and contradications of vaccines, and the recognition and treatment of emergency reactions to vaccines, and maintains that training.
(B)Is certified in basic life support.
(C)Complies with all state and federal recordkeeping and reporting requirements, including providing documentation to the patients primary care provided and entering information in the appropriate immunization registry designated by the immunization branch of the State Department of Public Health.
(D)Applies for an immunization certificate on a board-approved form.
(2)For the purposes of this section, immunization means the administration of immunizations for influenza, herpes zoster virus, and pneumococcus in compliance with individual Advisory Committee on Immunization Practices (ACIP) vaccine recommendations published by the CDC for persons 18 years of age or older.
(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)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 paragraphs (1) to (15), inclusive, of subdivision (d). This subdivision does not limit an optometrists authority to utilize diagnostic laser and ultrasound technology within his or her scope of practice.
(j)An optometrist licensed under this chapter is subject to the provisions of Section 2290.5 for purposes of practicing telehealth.
(k)For purposes of this chapter, glaucoma means either of the following:
(1)All primary open-angle glaucoma.
(2)Exfoliation and pigmentary glaucoma.
(3)(A)Steroid induced glaucoma.
(B)If an optometrist treats a patient for steroid induced glaucoma the optometrist shall promptly notify the prescriber of the steroid medication if the prescriber did not refer the patient to the optometrist for treatment.
(l)For purposes of this chapter, adnexa means ocular adnexa.
(m)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. 3.Section 3041.1 of the Business and Professions Code is amended to read:3041.1.An optometrist 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 optometristss scope of practice. Consultations, referrals, and notifications required by this section shall be documented in the patient record.
SEC. 4.Section 3041.2 of the Business and Professions Code is amended to read:3041.2.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 educational and examination requirements shall be a condition for the issuance of an original optometrist license or certifications pursuant to this chapter.
SEC. 5.Section 3041.3 of the Business and Professions Code is amended to read: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) and (d) 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 therapeutic pharmaceutical agents (TPA) certification 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)Completes a preceptorship of no less than 65 hours, during a period of not less than two months nor more than one year, with either a TPA-certified optometrist in good standing or a physician and surgeon board-certified in ophthalmology in good standing. The training received during the preceptorship shall be on the diagnosis, treatment, and management of ocular and systemic disease. The preceptor shall certify completion of the preceptorship using a form approved by the board. 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 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.
(2)Successfully completes a minimum of 100 hours of directed and accredited education in ocular and systemic diseases within two years prior to meeting the requirements of paragraph (1).
(3)Passes the National Board of Examiners in Optometrys 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.
(c)The board shall grant a therapeutic pharmaceutical agents certification 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 passes all sections of the National Board of Examiners in Optometrys national board examination or its equivalent, as determined by the State Board of Optometry.
(d)The board shall grant a therapeutic pharmaceutical agents certification 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 granted a therapeutic pharmaceutical agents certification.
(1)In order to obtain a therapeutic pharmaceutical agents certification, 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 therapeutic pharmaceutical agents certification, 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 therapeutic pharmaceutical agents certification, 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 therapeutic pharmaceutical agents certification, 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 optometrists education or training under this subdivision.
SEC. 6.Section 3056 of the Business and Professions Code is amended to read:3056.(a)The board may issue a license to practice optometry to a person who meets all of the following qualifications:
(1)Has a degree as a doctor of optometry issued by an accredited school or college of optometry.
(2)Is currently licensed in another state.
(3)Is currently a full-time faculty member of an accredited California school or college of optometry and has served in that capacity for a period of at least five continuous years.
(4)Has attained, at an accredited California school or college of optometry, the academic rank of professor, associate professor, or clinical professor, except that the status of adjunct or affiliated faculty member shall not be deemed sufficient.
(5)Has successfully passed the boards jurisprudence examination.
(6)Is in good standing, with no past or pending malpractice awards or judicial or administrative actions.
(7)Has met the minimum continuing education requirements set forth in Section 3059 for the current and preceding year.
(8)Has met the requirements of Section 3041.3 regarding the use of therapeutic pharmaceutical agents under subdivision (d) of Section 3041.
(9)Has never had his or her license to practice optometry revoked or suspended.
(10)(A)Is not subject to denial based on any of the grounds listed in Section 480.
(B)Is not currently required to register as a sex offender pursuant to Section 290 of the Penal Code.
(11)Pays an application fee in an amount equal to the application fee prescribed by the board pursuant to Section 3152.
(12)Files an application on a form prescribed by the board.
(b)Any license issued pursuant to this section shall expire as provided in Section 3146, and may be renewed as provided in this chapter, subject to the same conditions as other licenses issued under this chapter.
(c)The term in good standing, as used in this section, means that a person under this section:
(1)Is not currently under investigation nor has been charged with an offense for any act substantially related to the practice of optometry by any public agency, nor entered into any consent agreement or subject to an administrative decision that contains conditions placed by an agency upon a persons professional conduct or practice, including any voluntary surrender of license, nor been the subject of an adverse judgment resulting from the practice of optometry that the board determines constitutes evidence of a pattern of incompetence or negligence.
(2)Has no physical or mental impairment related to drugs or alcohol, and has not been found mentally incompetent by a physician so that the person is unable to undertake the practice of optometry in a manner consistent with the safety of a patient or the public.
SEC. 7.Section 3057 of the Business and Professions Code is amended to read:3057.(a)The board may issue a license to practice optometry to a person who meets all of the following requirements:
(1)Has a degree as a doctor of optometry issued by an accredited school or college of optometry.
(2)Has successfully passed the licensing examination for an optometric license in another state.
(3)Submits proof that he or she is licensed in good standing as of the date of application in every state where he or she holds a license, including compliance with continuing education requirements.
(4)Is not subject to disciplinary action as set forth in subdivision (h) of Section 3110. If the person has been subject to disciplinary action, the board shall review that action to determine if it presents sufficient evidence of a violation of this chapter to warrant the submission of additional information from the person or the denial of the application for licensure.
(5)Has furnished a signed release allowing the disclosure of information from the National Practitioner Database and, if applicable, the verification of registration status with the federal Drug Enforcement Administration. The board shall review this information to determine if it presents sufficient evidence of a violation of this chapter to warrant the submission of additional information from the person or the denial of the application for licensure.
(6)Has never had his or her license to practice optometry revoked or suspended in any state where the person holds a license.
(7)(A)Is not subject to denial of an application for licensure based on any of the grounds listed in Section 480.
(B)Is not currently required to register as a sex offender pursuant to Section 290 of the Penal Code.
(8)Has met the minimum continuing education requirements set forth in Section 3059 for the current and preceding year.
(9)Has met the certification requirements of Section 3041.3 to use therapeutic pharmaceutical agents under subdivision (d) of Section 3041.
(10)Submits any other information as specified by the board to the extent it is required for licensure by examination under this chapter.
(11)Files an application on a form prescribed by the board, with an acknowledgment by the person executed under penalty of perjury and automatic forfeiture of license, of the following:
(A)That the information provided by the person to the board is true and correct, to the best of his or her knowledge and belief.
(B)That the person has not been convicted of an offense involving conduct that would violate Section 810.
(12)Pays an application fee in an amount equal to the application fee prescribed pursuant to subdivision (a) of Section 3152.
(13)Has successfully passed the boards jurisprudence examination.
(b)If the board finds that the competency of a candidate for licensure pursuant to this section is in question, the board may require the passage of a written, practical, or clinical examination or completion of additional continuing education or coursework.
(c)In cases where the person establishes, to the boards satisfaction, that he or she has been displaced by a federally declared emergency and cannot relocate to his or her state of practice within a reasonable time without economic hardship, the board may reduce or waive the fees required by paragraph (12) of subdivision (a).
(d)Any license issued pursuant to this section shall expire as provided in Section 3146, and may be renewed as provided in this chapter, subject to the same conditions as other licenses issued under this chapter.
(e)The term in good standing, as used in this section, means that a person under this section:
(1)Is not currently under investigation nor has been charged with an offense for any act substantially related to the practice of optometry by any public agency, nor entered into any consent agreement or subject to an administrative decision that contains conditions placed by an agency upon a persons professional conduct or practice, including any voluntary surrender of license, nor been the subject of an adverse judgment resulting from the practice of optometry that the board determines constitutes evidence of a pattern of incompetence or negligence.
(2)Has no physical or mental impairment related to drugs or alcohol, and has not been found mentally incompetent by a licensed psychologist or licensed psychiatrist so that the person is unable to undertake the practice of optometry in a manner consistent with the safety of a patient or the public.
SEC. 7.5.Section 3057 of the Business and Professions Code is amended to read:3057.(a)The board may issue a license to practice optometry to a person who meets all of the following requirements:
(1)Has a degree as a doctor of optometry issued by an accredited school or college of optometry.
(2)Has successfully passed the licensing examination for an optometric license in another state.
(3)Submits proof that he or she is licensed in good standing as of the date of application in every state where he or she holds a license, including compliance with continuing education requirements.
(4)Is not subject to disciplinary action as set forth in subdivision (h) of Section 3110. If the person has been subject to disciplinary action, the board shall review that action to determine if it presents sufficient evidence of a violation of this chapter to warrant the submission of additional information from the person or the denial of the application for licensure.
(5)Has furnished a signed release allowing the disclosure of information from the National Practitioner Data Bank and, if applicable, the verification of registration status with the federal Drug Enforcement Administration. The board shall review this information to determine if it presents sufficient evidence of a violation of this chapter to warrant the submission of additional information from the person or the denial of the application for licensure.
(6)Has never had his or her license to practice optometry revoked or suspended in any state where the person holds a license. This paragraph shall become inoperative on July 1, 2018.
(7)(A)Is not subject to denial of an application for licensure based on any of the grounds listed in Section 480.
(B)Is not currently required to register as a sex offender pursuant to Section 290 of the Penal Code.
(8)Has met the minimum continuing education requirements set forth in Section 3059 for the current and preceding year.
(9)Has met the certification requirements of Section 3041.3 to use therapeutic pharmaceutical agents under subdivision (d) of Section 3041.
(10)Submits any other information as specified by the board to the extent it is required for licensure by examination under this chapter.
(11)Files an application on a form prescribed by the board, with an acknowledgment by the person executed under penalty of perjury and automatic forfeiture of license, of the following:
(A)That the information provided by the person to the board is true and correct, to the best of his or her knowledge and belief.
(B)That the person has not been convicted of an offense involving conduct that would violate Section 810.
(12)Pays an application fee in an amount equal to the application fee prescribed pursuant to subdivision (a) of Section 3152.
(13)Has successfully passed the boards jurisprudence examination.
(b)If the board finds that the competency of a candidate for licensure pursuant to this section is in question, the board may require the passage of a written, practical, or clinical examination or completion of additional continuing education or coursework.
(c)In cases where the person establishes, to the boards satisfaction, that he or she has been displaced by a federally declared emergency and cannot relocate to his or her state of practice within a reasonable time without economic hardship, the board may reduce or waive the fees required by paragraph (12) of subdivision (a).
(d)Any license issued pursuant to this section shall expire as provided in Section 3146, and may be renewed as provided in this chapter, subject to the same conditions as other licenses issued under this chapter.
(e)The term in good standing, as used in this section, means that a person under this section:
(1)Is not currently under investigation nor has been charged with an offense for any act substantially related to the practice of optometry by any public agency, nor entered into any consent agreement or subject to an administrative decision that contains conditions placed by an agency upon a persons professional conduct or practice, including any voluntary surrender of license, nor been the subject of an adverse judgment resulting from the practice of optometry that the board determines constitutes evidence of a pattern of incompetence or negligence.
(2)Has no physical or mental impairment related to drugs or alcohol, and has not been found mentally incompetent by a licensed psychologist or licensed psychiatrist so that the person is unable to undertake the practice of optometry in a manner consistent with the safety of a patient or the public.
SEC. 8.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 licensees 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 bloodborne 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 bloodborne pathogens in health care settings. As necessary, the board may consult with the Medical Board of California, the California Board of Podiatric Medicine, the Board of Registered Nursing, and the Board of Vocational Nursing and Psychiatric Technicians of the State of California, 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 patients 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 and surgeon if an examination of the eyes indicates a substantial likelihood of any pathology that requires the attention of that physician and surgeon.
SEC. 9.Section 3152 of the Business and Professions Code is amended to read:3152.The amounts of fees and penalties prescribed by this chapter shall be established by the board in amounts not greater than those specified in the following schedule:
(a)The fee for applicants applying for a license shall not exceed two hundred seventy-five dollars ($275).
(b)The fee for renewal of an optometric license shall not exceed five hundred dollars ($500).
(c)The annual fee for the renewal of a branch office license shall not exceed seventy-five dollars ($75).
(d)The fee for a branch office license shall not exceed seventy-five dollars ($75).
(e)The penalty for failure to pay the annual fee for renewal of a branch office license shall not exceed twenty-five dollars ($25).
(f)The fee for issuance of a license or upon change of name authorized by law of a person holding a license under this chapter shall not exceed twenty-five dollars ($25).
(g)The delinquency fee for renewal of an optometric license shall not exceed fifty dollars ($50).
(h)The application fee for a certificate to perform lacrimal irrigation and dilation shall not exceed fifty dollars ($50).
(i)The application fee for a certificate to treat glaucoma shall not exceed fifty dollars ($50).
(j)The fee for approval of a continuing education course shall not exceed one hundred dollars ($100).
(k)The fee for issuance of a statement of licensure shall not exceed forty dollars ($40).
(l)The fee for biennial renewal of a statement of licensure shall not exceed forty dollars ($40).
(m)The delinquency fee for renewal of a statement of licensure shall not exceed twenty dollars ($20).
(n)The application fee for a fictitious name permit shall not exceed fifty dollars ($50).
(o)The renewal fee for a fictitious name permit shall not exceed fifty dollars ($50).
(p)The delinquency fee for renewal of a fictitious name permit shall not exceed twenty-five dollars ($25).
(q)The fee for a retired license shall not exceed twenty-five dollars ($25).
(r)The fee for a retired license with volunteer designation shall not exceed fifty dollars ($50).
(s)The biennial renewal fee for a retired license with volunteer designation shall not exceed fifty dollars ($50).
(t)The application fee for a certificate to administer immunizations shall not exceed fifty dollars ($50).
SEC. 10.Section 7.5 of this bill incorporates amendments to Section 3057 of the Business and Professions Code proposed by both this bill and Assembly Bill 1708. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2018, (2) each bill amends Section 3057 of the Business and Professions Code, and (3) this bill is enacted after Assembly Bill 1708, in which case Section 7 of this bill shall not become operative.
SEC. 11.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
(a)As used in this chapter, laboratory director means any person who is any of the following:
(1)A duly licensed physician and surgeon.
(2)Only for purposes of a clinical laboratory test or examination classified as waived, is any of the following:
(A)A duly licensed clinical laboratory scientist.
(B)A duly licensed limited clinical laboratory scientist.
(C)A duly licensed naturopathic doctor.
(D)A duly licensed optometrist serving as the director of a laboratory that only performs clinical laboratory tests authorized in paragraph (10) of subdivision (d) of Section 3041.
(3)Licensed to direct a clinical laboratory under this chapter.
(b)(1)A person defined in paragraph (1) or (3) of subdivision (a) who is identified as the CLIA laboratory director of a laboratory that performs clinical laboratory tests classified as moderate or high complexity shall also meet the laboratory director qualifications under CLIA for the type and complexity of tests being offered by the laboratory.
(2)As used in this subdivision, CLIA laboratory director means the person identified as the laboratory director on the CLIA certificate issued to the laboratory by the federal Centers for Medicare and Medicaid Services (CMS).
(c)The laboratory director, if qualified under CLIA, may perform the duties of the technical consultant, technical supervisor, clinical consultant, general supervisor, and testing personnel, or delegate these responsibilities to persons qualified under CLIA. If the laboratory director reapportions performance of those responsibilities or duties, he or she shall remain responsible for ensuring that all those duties and responsibilities are properly performed.
(d)(1)The laboratory director is responsible for the overall operation and administration of the clinical laboratory, including administering the technical and scientific operation of a clinical laboratory, the selection and supervision of procedures, the reporting of results, and active participation in its operations to the extent necessary to ensure compliance with this act and CLIA. He or she shall be responsible for the proper performance of all laboratory work of all subordinates and shall employ a sufficient number of laboratory personnel with the appropriate education and either experience or training to provide appropriate consultation, properly supervise and accurately perform tests, and report test results in accordance with the personnel qualifications, duties, and responsibilities described in CLIA and this chapter.
(2)Where a point-of-care laboratory testing device is utilized and provides results for more than one analyte, the testing personnel may perform and report the results of all tests ordered for each analyte for which he or she has been found by the laboratory director to be competent to perform and report.
(e)As part of the overall operation and administration, the laboratory director of a registered laboratory shall document the adequacy of the qualifications (educational background, training, and experience) of the personnel directing and supervising the laboratory and performing the laboratory test procedures and examinations. In determining the adequacy of qualifications, the laboratory director shall comply with any regulations adopted by the department that specify the minimum qualifications for personnel, in addition to any CLIA requirements relative to the education or training of personnel.
(f)As part of the overall operation and administration, the laboratory director of a licensed laboratory shall do all of the following:
(1)Ensure that all personnel, prior to testing biological specimens, have the appropriate education and experience, receive the appropriate training for the type and complexity of the services offered, and have demonstrated that they can perform all testing operations reliably to provide and report accurate results. In determining the adequacy of qualifications, the laboratory director shall comply with any regulations adopted by the department that specify the minimum qualifications for, and the type of procedures that may be performed by, personnel in addition to any CLIA requirements relative to the education or training of personnel. Any regulations adopted pursuant to this section that specify the type of procedure that may be performed by testing personnel shall be based on the skills, knowledge, and tasks required to perform the type of procedure in question.
(2)Ensure that policies and procedures are established for monitoring individuals who conduct preanalytical, analytical, and postanalytical phases of testing to ensure that they are competent and maintain their competency to process biological specimens, perform test procedures, and report test results promptly and proficiently, and, whenever necessary, identify needs for remedial training or continuing education to improve skills.
(3)Specify in writing the responsibilities and duties of each individual engaged in the performance of the preanalytic, analytic, and postanalytic phases of clinical laboratory tests or examinations, including which clinical laboratory tests or examinations the individual is authorized to perform, whether supervision is required for the individual to perform specimen processing, test performance, or results reporting, and whether consultant, supervisor, or director review is required prior to the individual reporting patient test results.
(g)The competency and performance of staff of a licensed laboratory shall be evaluated and documented by the laboratory director, or by a person who qualifies as a technical consultant or a technical supervisor under CLIA depending on the type and complexity of tests being offered by the laboratory.
(1)The procedures for evaluating the competency of the staff shall include, but are not limited to, all of the following:
(A)Direct observations of routine patient test performance, including patient preparation, if applicable, and specimen handling, processing, and testing.
(B)Monitoring the recording and reporting of test results.
(C)Review of intermediate test results or worksheets, quality control records, proficiency testing results, and preventive maintenance records.
(D)Direct observation of performance of instrument maintenance and function checks.
(E)Assessment of test performance through testing previously analyzed specimens, internal blind testing samples, or external proficiency testing samples.
(F)Assessment of problem solving skills.
(2)Evaluation and documentation of staff competency and performance shall occur at least semiannually during the first year an individual tests biological specimens. Thereafter, evaluations shall be performed at least annually unless test methodology or instrumentation changes, in which case, prior to reporting patient test results, the individuals performance shall be reevaluated to include the use of the new test methodology or instrumentation.
(h)The laboratory director of each clinical laboratory of an acute care hospital shall be a physician and surgeon who is a qualified pathologist, except as follows:
(1)If a qualified pathologist is not available, a physician and surgeon or a clinical laboratory bioanalyst qualified as a laboratory director under subdivision (a) may direct the laboratory. However, a qualified pathologist shall be available for consultation at suitable intervals to ensure high-quality service.
(2)If there are two or more clinical laboratories of an acute care hospital, those additional clinical laboratories that are limited to the performance of blood gas analysis, blood electrolyte analysis, or both, may be directed by a physician and surgeon qualified as a laboratory director under subdivision (a), irrespective of whether a pathologist is available.
As used in this subdivision, a qualified pathologist is a physician and surgeon certified or eligible for certification in clinical or anatomical pathology by the American Board of Pathology or the American Osteopathic Board of Pathology.
(i)Subdivision (h) does not apply to any director of a clinical laboratory of an acute care hospital acting in that capacity on or before January 1, 1988.
(j)A laboratory director may serve as the director of up to the maximum number of laboratories stipulated by CLIA, as defined under Section 1202.5.
SEC. 2.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.
(D)Traumatic or recurrent conjunctival or corneal abrasions and erosions.
(E)Nonmalignant ocular surface disease and dry eye disease.
(F)Ocular pain, nonsurgical in cause except when comanaged with the treating physician and surgeon, associated with conditions optometrists are authorized to treat.
(G)Hypotrichosis and blepharitis.
(H)Pursuant to subdivision (e), 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 (d).
(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 or prescribe, including for rational off-label purposes, all of the following therapeutic pharmaceutical agents:
(1)Topical pharmaceutical agents for the examination of the human eye or eyes for any disease or pathological condition, including, but not limited to, 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 patients condition worsens 21 days after diagnosis.
(4)Topical and oral anti-inflammatories.
(5)Topical antibiotic agents.
(6)Topical hyperosmotics.
(7)Topical and oral antiglaucoma agents pursuant to the certification process defined in subdivision (e).
(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.
(12)Topical and oral antiviral medication for the medical treatment of herpes simplex viral keratitis, herpes simplex viral conjunctivitis, periocular herpes simplex viral dermatitis, varicella zoster viral keratitis, varicella zoster viral conjunctivitis, and periocular varicella zoster viral dermatitis.
(13)Oral analgesics that are not controlled substances.
(14)Codeine with compounds, hydrocodone with compound, compounds, and tramadol 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.
(15)Additional therapeutic pharmaceutical agents pursuant to subdivision (f).
(d)An optometrist who is certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 may also perform all of the following procedures:
(1)Corneal scraping with cultures.
(2)Debridement of corneal epithelia.
(3)Mechanical epilation.
(4)Collection of blood by skin puncture or 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 the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA) (42 U.S.C. Sec. 263a; Public Law 100-578) 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)Skin testing to diagnose ocular allergies, limited to the superficial layer of the skin. (12)(11)Punctal occlusion by plugs, excluding laser, diathermy, cryotherapy, or other means constituting surgery as defined in this chapter.
(13)(12)The use or prescription of diagnostic or therapeutic contact lenses, including lenses or devices that incorporate a medication or therapy the optometrist is certified to prescribe or provide.
(14)(13)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.
(15)(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.
(15)Intravenous injection for the purpose of performing ocular angiography at the direction of an ophthalmologist as part of an active treatment plan in a setting where a physician and surgeon is immediately available.
(16)Skin testing to diagnose ocular allergies, limited to the superficial layer of the skin.
(16)(17)Use of any topical or oral therapeutic pharmaceutical agent or noninvasive medical device or technology authorized pursuant to subdivision (f).
(e)An optometrist certified pursuant to Section 3041.3 shall be certified 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 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 who are not described in paragraph (2) or (3), submission of proof of satisfactory completion of the requirements for certification established by the board. board under Chapter 352 of the Statutes of 2008.
(f)(1)Any topical or oral therapeutic pharmaceutical agent, which is not a controlled substance, or noninvasive medical device or technology whose use does not constitute surgery, as defined in subdivision (i), that is not expressly authorized for use or prescription by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 shall be deemed to be authorized if it has received a United States Food and Drug Administration approved indication for the diagnosis or treatment of a condition authorized by this chapter. A licensee shall successfully complete any clinical training imposed by a related manufacturer prior to using any of those therapeutic pharmaceutical agents or noninvasive medical devices or technologies.
(2)Any other topical or oral therapeutic pharmaceutical agent, which is not a controlled substance, or noninvasive medical device or technology whose use does not constitute surgery, as defined in subdivision (i), that is not expressly authorized for use or prescription by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 and does not meet the requirements in paragraph (1) shall be deemed authorized if approved by the board through regulation for the rational treatment of a condition authorized by this chapter. Any regulation under this paragraph shall require a licensee to successfully complete an appropriate amount of clinical training to qualify to use each topical or oral therapeutic pharmaceutical agent or noninvasive medical device or technology approved by the board pursuant to this paragraph.
(3)The This subdivision shall not be construed to authorize either any of the following:
(A)Injections administered for cosmetic effect.(B)The performance of blepharoplasty or other cosmetic surgery procedure that reshapes the normal structures of the body in order to improve appearance and self-esteem.(A)Any therapeutic pharmaceutical agent, medical device, or technology involving cutting, altering, or otherwise infiltrating human tissue by any means.
(B)A clinical laboratory test or imaging study not authorized by paragraphs (1) to (16), inclusive, of subdivision (d).
(C)Treatment of any disease or condition that could not be treated by an optometrist before January 1, 2018.
(g)(1)An optometrist certified pursuant to Section 3014.3 shall be certified for the administration of immunizations after the optometrist meets all of the following requirements:
(A)Completes an immunization training program endorsed by the federal Centers for Disease Control and Prevention (CDC) that, at a minimum, includes hands-on injection technique, clinical evaluation of indications and contradications of vaccines, and the recognition and treatment of emergency reactions to vaccines, and maintains that training.
(B)Is certified in basic life support.
(C)Complies with all state and federal recordkeeping and reporting requirements, including providing documentation to the patients primary care provided and entering information in the appropriate immunization registry designated by the immunization branch of the State Department of Public Health.
(D)Applies for an immunization certificate on a board-approved form.
(2)For the purposes of this section, immunization means the administration of immunizations for influenza, herpes zoster virus, and pneumococcus in compliance with individual Advisory Committee on Immunization Practices (ACIP) vaccine recommendations published by the CDC for persons 18 years of age or older.
(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)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 paragraphs (1) to (15), inclusive, of subdivision (d). This subdivision does not limit an optometrists authority to utilize diagnostic laser and ultrasound technology within his or her scope of practice.
(j)An optometrist licensed under this chapter is subject to the provisions of Section 2290.5 for purposes of practicing telehealth.
(k)For purposes of this chapter, glaucoma means either of the following:
(1)All primary open-angle glaucoma.
(2)Exfoliation and pigmentary glaucoma.
(3)(A)Steroid induced glaucoma.
(B)If an optometrist treats a patient for steroid induced glaucoma the optometrist shall promptly notify the prescriber of the steroid medication if the prescriber did not refer the patient to the optometrist for treatment.
(l)For purposes of this chapter, adnexa means ocular adnexa.
(m)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. 3.Section 3041.1 of the Business and Professions Code is amended to read:3041.1.An optometrist 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 optometristss scope of practice. Consultations, referrals, and notifications required by this section shall be documented in the patient record.
SEC. 4.Section 3041.2 of the Business and Professions Code is amended to read:3041.2.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 educational and examination requirements shall be a condition for the issuance of an original optometrist license or certifications pursuant to this chapter.
SEC. 5.Section 3041.3 of the Business and Professions Code is amended to read: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) and (d) 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 therapeutic pharmaceutical agents (TPA) certification 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)Completes a preceptorship of no less than 65 hours, during a period of not less than two months nor more than one year, with either a TPA-certified optometrist in good standing or a physician and surgeon board-certified in ophthalmology in good standing. The training received during the preceptorship shall be on the diagnosis, treatment, and management of ocular and systemic disease. The preceptor shall certify completion of the preceptorship using a form approved by the board. 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 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.
(2)Successfully completes a minimum of 100 hours of directed and accredited education in ocular and systemic diseases within two years prior to meeting the requirements of paragraph (1).
(3)Passes the National Board of Examiners in Optometrys 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.
(c)The board shall grant a therapeutic pharmaceutical agents certification 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 passes all sections of the National Board of Examiners in Optometrys national board examination or its equivalent, as determined by the State Board of Optometry.
(d)The board shall grant a therapeutic pharmaceutical agents certification 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 granted a therapeutic pharmaceutical agents certification.
(1)In order to obtain a therapeutic pharmaceutical agents certification, 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 therapeutic pharmaceutical agents certification, 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 therapeutic pharmaceutical agents certification, 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 therapeutic pharmaceutical agents certification, 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 optometrists education or training under this subdivision.
SEC. 6.Section 3056 of the Business and Professions Code is amended to read:3056.(a)The board may issue a license to practice optometry to a person who meets all of the following qualifications:
(1)Has a degree as a doctor of optometry issued by an accredited school or college of optometry.
(2)Is currently licensed in another state.
(3)Is currently a full-time faculty member of an accredited California school or college of optometry and has served in that capacity for a period of at least five continuous years.
(4)Has attained, at an accredited California school or college of optometry, the academic rank of professor, associate professor, or clinical professor, except that the status of adjunct or affiliated faculty member shall not be deemed sufficient.
(5)Has successfully passed the boards jurisprudence examination.
(6)Is in good standing, with no past or pending malpractice awards or judicial or administrative actions.
(7)Has met the minimum continuing education requirements set forth in Section 3059 for the current and preceding year.
(8)Has met the requirements of Section 3041.3 regarding the use of therapeutic pharmaceutical agents under subdivision (d) of Section 3041.
(9)Has never had his or her license to practice optometry revoked or suspended.
(10)(A)Is not subject to denial based on any of the grounds listed in Section 480.
(B)Is not currently required to register as a sex offender pursuant to Section 290 of the Penal Code.
(11)Pays an application fee in an amount equal to the application fee prescribed by the board pursuant to Section 3152.
(12)Files an application on a form prescribed by the board.
(b)Any license issued pursuant to this section shall expire as provided in Section 3146, and may be renewed as provided in this chapter, subject to the same conditions as other licenses issued under this chapter.
(c)The term in good standing, as used in this section, means that a person under this section:
(1)Is not currently under investigation nor has been charged with an offense for any act substantially related to the practice of optometry by any public agency, nor entered into any consent agreement or subject to an administrative decision that contains conditions placed by an agency upon a persons professional conduct or practice, including any voluntary surrender of license, nor been the subject of an adverse judgment resulting from the practice of optometry that the board determines constitutes evidence of a pattern of incompetence or negligence.
(2)Has no physical or mental impairment related to drugs or alcohol, and has not been found mentally incompetent by a physician so that the person is unable to undertake the practice of optometry in a manner consistent with the safety of a patient or the public.
SEC. 7.Section 3057 of the Business and Professions Code is amended to read:3057.(a)The board may issue a license to practice optometry to a person who meets all of the following requirements:
(1)Has a degree as a doctor of optometry issued by an accredited school or college of optometry.
(2)Has successfully passed the licensing examination for an optometric license in another state.
(3)Submits proof that he or she is licensed in good standing as of the date of application in every state where he or she holds a license, including compliance with continuing education requirements.
(4)Is not subject to disciplinary action as set forth in subdivision (h) of Section 3110. If the person has been subject to disciplinary action, the board shall review that action to determine if it presents sufficient evidence of a violation of this chapter to warrant the submission of additional information from the person or the denial of the application for licensure.
(5)Has furnished a signed release allowing the disclosure of information from the National Practitioner Database and, if applicable, the verification of registration status with the federal Drug Enforcement Administration. The board shall review this information to determine if it presents sufficient evidence of a violation of this chapter to warrant the submission of additional information from the person or the denial of the application for licensure.
(6)Has never had his or her license to practice optometry revoked or suspended in any state where the person holds a license.
(7)(A)Is not subject to denial of an application for licensure based on any of the grounds listed in Section 480.
(B)Is not currently required to register as a sex offender pursuant to Section 290 of the Penal Code.
(8)Has met the minimum continuing education requirements set forth in Section 3059 for the current and preceding year.
(9)Has met the certification requirements of Section 3041.3 to use therapeutic pharmaceutical agents under subdivision (d) of Section 3041.
(10)Submits any other information as specified by the board to the extent it is required for licensure by examination under this chapter.
(11)Files an application on a form prescribed by the board, with an acknowledgment by the person executed under penalty of perjury and automatic forfeiture of license, of the following:
(A)That the information provided by the person to the board is true and correct, to the best of his or her knowledge and belief.
(B)That the person has not been convicted of an offense involving conduct that would violate Section 810.
(12)Pays an application fee in an amount equal to the application fee prescribed pursuant to subdivision (a) of Section 3152.
(13)Has successfully passed the boards jurisprudence examination.
(b)If the board finds that the competency of a candidate for licensure pursuant to this section is in question, the board may require the passage of a written, practical, or clinical examination or completion of additional continuing education or coursework.
(c)In cases where the person establishes, to the boards satisfaction, that he or she has been displaced by a federally declared emergency and cannot relocate to his or her state of practice within a reasonable time without economic hardship, the board may reduce or waive the fees required by paragraph (12) of subdivision (a).
(d)Any license issued pursuant to this section shall expire as provided in Section 3146, and may be renewed as provided in this chapter, subject to the same conditions as other licenses issued under this chapter.
(e)The term in good standing, as used in this section, means that a person under this section:
(1)Is not currently under investigation nor has been charged with an offense for any act substantially related to the practice of optometry by any public agency, nor entered into any consent agreement or subject to an administrative decision that contains conditions placed by an agency upon a persons professional conduct or practice, including any voluntary surrender of license, nor been the subject of an adverse judgment resulting from the practice of optometry that the board determines constitutes evidence of a pattern of incompetence or negligence.
(2)Has no physical or mental impairment related to drugs or alcohol, and has not been found mentally incompetent by a licensed psychologist or licensed psychiatrist so that the person is unable to undertake the practice of optometry in a manner consistent with the safety of a patient or the public.
SEC. 7.5.Section 3057 of the Business and Professions Code is amended to read:3057.(a)The board may issue a license to practice optometry to a person who meets all of the following requirements:
(1)Has a degree as a doctor of optometry issued by an accredited school or college of optometry.
(2)Has successfully passed the licensing examination for an optometric license in another state.
(3)Submits proof that he or she is licensed in good standing as of the date of application in every state where he or she holds a license, including compliance with continuing education requirements.
(4)Is not subject to disciplinary action as set forth in subdivision (h) of Section 3110. If the person has been subject to disciplinary action, the board shall review that action to determine if it presents sufficient evidence of a violation of this chapter to warrant the submission of additional information from the person or the denial of the application for licensure.
(5)Has furnished a signed release allowing the disclosure of information from the National Practitioner Database Data Bank and, if applicable, the verification of registration status with the federal Drug Enforcement Administration. The board shall review this information to determine if it presents sufficient evidence of a violation of this chapter to warrant the submission of additional information from the person or the denial of the application for licensure.
(6)Has never had his or her license to practice optometry revoked or suspended in any state where the person holds a license. This paragraph shall become inoperative on July 1, 2018.
(7)(A)Is not subject to denial of an application for licensure based on any of the grounds listed in Section 480.
(B)Is not currently required to register as a sex offender pursuant to Section 290 of the Penal Code.
(8)Has met the minimum continuing education requirements set forth in Section 3059 for the current and preceding year.
(9)Has met the certification requirements of Section 3041.3 to use therapeutic pharmaceutical agents under subdivision (e) (d) of Section 3041.
(10)Submits any other information as specified by the board to the extent it is required for licensure by examination under this chapter.
(11)Files an application on a form prescribed by the board, with an acknowledgment by the person executed under penalty of perjury and automatic forfeiture of license, of the following:
(A)That the information provided by the person to the board is true and correct, to the best of his or her knowledge and belief.
(B)That the person has not been convicted of an offense involving conduct that would violate Section 810.
(12)Pays an application fee in an amount equal to the application fee prescribed pursuant to subdivision (a) of Section 3152.
(13)Has successfully passed the boards jurisprudence examination.
(b)If the board finds that the competency of a candidate for licensure pursuant to this section is in question, the board may require the passage of a written, practical, or clinical examination or completion of additional continuing education or coursework.
(c)In cases where the person establishes, to the boards satisfaction, that he or she has been displaced by a federally declared emergency and cannot relocate to his or her state of practice within a reasonable time without economic hardship, the board may reduce or waive the fees required by paragraph (12) of subdivision (a).
(d)Any license issued pursuant to this section shall expire as provided in Section 3146, and may be renewed as provided in this chapter, subject to the same conditions as other licenses issued under this chapter.
(e)The term in good standing, as used in this section, means that a person under this section:
(1)Is not currently under investigation nor has been charged with an offense for any act substantially related to the practice of optometry by any public agency, nor entered into any consent agreement or subject to an administrative decision that contains conditions placed by an agency upon a persons professional conduct or practice, including any voluntary surrender of license, nor been the subject of an adverse judgment resulting from the practice of optometry that the board determines constitutes evidence of a pattern of incompetence or negligence.
(2)Has no physical or mental impairment related to drugs or alcohol, and has not been found mentally incompetent by a licensed psychologist or licensed psychiatrist so that the person is unable to undertake the practice of optometry in a manner consistent with the safety of a patient or the public.
SEC. 8.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 licensees 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 bloodborne 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 bloodborne pathogens in health care settings. As necessary, the board may consult with the Medical Board of California, the California Board of Podiatric Medicine, the Board of Registered Nursing, and the Board of Vocational Nursing and Psychiatric Technicians of the State of California, 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 patients 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 and surgeon if an examination of the eyes indicates a substantial likelihood of any pathology that requires the attention of that physician and surgeon.
SEC. 9.Section 3152 of the Business and Professions Code is amended to read:3152.The amounts of fees and penalties prescribed by this chapter shall be established by the board in amounts not greater than those specified in the following schedule:
(a)The fee for applicants applying for a license shall not exceed two hundred seventy-five dollars ($275).
(b)The fee for renewal of an optometric license shall not exceed five hundred dollars ($500).
(c)The annual fee for the renewal of a branch office license shall not exceed seventy-five dollars ($75).
(d)The fee for a branch office license shall not exceed seventy-five dollars ($75).
(e)The penalty for failure to pay the annual fee for renewal of a branch office license shall not exceed twenty-five dollars ($25).
(f)The fee for issuance of a license or upon change of name authorized by law of a person holding a license under this chapter shall not exceed twenty-five dollars ($25).
(g)The delinquency fee for renewal of an optometric license shall not exceed fifty dollars ($50).
(h)The application fee for a certificate to perform lacrimal irrigation and dilation shall not exceed fifty dollars ($50).
(i)The application fee for a certificate to treat glaucoma shall not exceed fifty dollars ($50).
(j)The fee for approval of a continuing education course shall not exceed one hundred dollars ($100).
(k)The fee for issuance of a statement of licensure shall not exceed forty dollars ($40).
(l)The fee for biennial renewal of a statement of licensure shall not exceed forty dollars ($40).
(m)The delinquency fee for renewal of a statement of licensure shall not exceed twenty dollars ($20).
(n)The application fee for a fictitious name permit shall not exceed fifty dollars ($50).
(o)The renewal fee for a fictitious name permit shall not exceed fifty dollars ($50).
(p)The delinquency fee for renewal of a fictitious name permit shall not exceed twenty-five dollars ($25).
(q)The fee for a retired license shall not exceed twenty-five dollars ($25).
(r)The fee for a retired license with volunteer designation shall not exceed fifty dollars ($50).
(s)The biennial renewal fee for a retired license with volunteer designation shall not exceed fifty dollars ($50).
(t)The application fee for a certificate to administer immunizations shall not exceed fifty dollars ($50).
SEC. 10.Section 7.5 of this bill incorporates amendments to Section 3057 of the Business and Professions Code proposed by both this bill and Assembly Bill 1708. That section of this bill shall only become operative if (1) both bills are enacted and become effective on or before January 1, 2018, (2) each bill amends Section 3057 of the Business and Professions Code, and (3) this bill is enacted after Assembly Bill 1708, in which case Section 7 of this bill shall not become operative.
SEC. 10. SEC. 11.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
(a)As used in this chapter, laboratory director means any person who is any of the following:
(1)A duly licensed physician and surgeon.
(2)Only for purposes of a clinical laboratory test or examination classified as waived, is any of the following:
(A)A duly licensed clinical laboratory scientist.
(B)A duly licensed limited clinical laboratory scientist.
(C)A duly licensed naturopathic doctor.
(D)A duly licensed optometrist serving as the director of a laboratory that only performs clinical laboratory tests authorized in paragraph (10) of subdivision (d) of Section 3041.
(3)Licensed to direct a clinical laboratory under this chapter.
(b)(1)A person defined in paragraph (1) or (3) of subdivision (a) who is identified as the CLIA laboratory director of a laboratory that performs clinical laboratory tests classified as moderate or high complexity shall also meet the laboratory director qualifications under CLIA for the type and complexity of tests being offered by the laboratory.
(2)As used in this subdivision, CLIA laboratory director means the person identified as the laboratory director on the CLIA certificate issued to the laboratory by the federal Centers for Medicare and Medicaid Services (CMS).
(c)The laboratory director, if qualified under CLIA, may perform the duties of the technical consultant, technical supervisor, clinical consultant, general supervisor, and testing personnel, or delegate these responsibilities to persons qualified under CLIA. If the laboratory director reapportions performance of those responsibilities or duties, he or she shall remain responsible for ensuring that all those duties and responsibilities are properly performed.
(d)(1)The laboratory director is responsible for the overall operation and administration of the clinical laboratory, including administering the technical and scientific operation of a clinical laboratory, the selection and supervision of procedures, the reporting of results, and active participation in its operations to the extent necessary to ensure compliance with this act and CLIA. He or she shall be responsible for the proper performance of all laboratory work of all subordinates and shall employ a sufficient number of laboratory personnel with the appropriate education and either experience or training to provide appropriate consultation, properly supervise and accurately perform tests, and report test results in accordance with the personnel qualifications, duties, and responsibilities described in CLIA and this chapter.
(2)Where a point-of-care laboratory testing device is utilized and provides results for more than one analyte, the testing personnel may perform and report the results of all tests ordered for each analyte for which he or she has been found by the laboratory director to be competent to perform and report.
(e)As part of the overall operation and administration, the laboratory director of a registered laboratory shall document the adequacy of the qualifications (educational background, training, and experience) of the personnel directing and supervising the laboratory and performing the laboratory test procedures and examinations. In determining the adequacy of qualifications, the laboratory director shall comply with any regulations adopted by the department that specify the minimum qualifications for personnel, in addition to any CLIA requirements relative to the education or training of personnel.
(f)As part of the overall operation and administration, the laboratory director of a licensed laboratory shall do all of the following:
(1)Ensure that all personnel, prior to testing biological specimens, have the appropriate education and experience, receive the appropriate training for the type and complexity of the services offered, and have demonstrated that they can perform all testing operations reliably to provide and report accurate results. In determining the adequacy of qualifications, the laboratory director shall comply with any regulations adopted by the department that specify the minimum qualifications for, and the type of procedures that may be performed by, personnel in addition to any CLIA requirements relative to the education or training of personnel. Any regulations adopted pursuant to this section that specify the type of procedure that may be performed by testing personnel shall be based on the skills, knowledge, and tasks required to perform the type of procedure in question.
(2)Ensure that policies and procedures are established for monitoring individuals who conduct preanalytical, analytical, and postanalytical phases of testing to ensure that they are competent and maintain their competency to process biological specimens, perform test procedures, and report test results promptly and proficiently, and, whenever necessary, identify needs for remedial training or continuing education to improve skills.
(3)Specify in writing the responsibilities and duties of each individual engaged in the performance of the preanalytic, analytic, and postanalytic phases of clinical laboratory tests or examinations, including which clinical laboratory tests or examinations the individual is authorized to perform, whether supervision is required for the individual to perform specimen processing, test performance, or results reporting, and whether consultant, supervisor, or director review is required prior to the individual reporting patient test results.
(g)The competency and performance of staff of a licensed laboratory shall be evaluated and documented by the laboratory director, or by a person who qualifies as a technical consultant or a technical supervisor under CLIA depending on the type and complexity of tests being offered by the laboratory.
(1)The procedures for evaluating the competency of the staff shall include, but are not limited to, all of the following:
(A)Direct observations of routine patient test performance, including patient preparation, if applicable, and specimen handling, processing, and testing.
(B)Monitoring the recording and reporting of test results.
(C)Review of intermediate test results or worksheets, quality control records, proficiency testing results, and preventive maintenance records.
(D)Direct observation of performance of instrument maintenance and function checks.
(E)Assessment of test performance through testing previously analyzed specimens, internal blind testing samples, or external proficiency testing samples.
(F)Assessment of problem solving skills.
(2)Evaluation and documentation of staff competency and performance shall occur at least semiannually during the first year an individual tests biological specimens. Thereafter, evaluations shall be performed at least annually unless test methodology or instrumentation changes, in which case, prior to reporting patient test results, the individuals performance shall be reevaluated to include the use of the new test methodology or instrumentation.
(h)The laboratory director of each clinical laboratory of an acute care hospital shall be a physician and surgeon who is a qualified pathologist, except as follows:
(1)If a qualified pathologist is not available, a physician and surgeon or a clinical laboratory bioanalyst qualified as a laboratory director under subdivision (a) may direct the laboratory. However, a qualified pathologist shall be available for consultation at suitable intervals to ensure high-quality service.
(2)If there are two or more clinical laboratories of an acute care hospital, those additional clinical laboratories that are limited to the performance of blood gas analysis, blood electrolyte analysis, or both, may be directed by a physician and surgeon qualified as a laboratory director under subdivision (a), irrespective of whether a pathologist is available.
As used in this subdivision, a qualified pathologist is a physician and surgeon certified or eligible for certification in clinical or anatomical pathology by the American Board of Pathology or the American Osteopathic Board of Pathology.
(i)Subdivision (h) does not apply to any director of a clinical laboratory of an acute care hospital acting in that capacity on or before January 1, 1988.
(j)A laboratory director may serve as the director of up to the maximum number of laboratories stipulated by CLIA, as defined under Section 1202.5.
SEC. 2.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.
(D)Traumatic or recurrent conjunctival or corneal abrasions and erosions.
(E)Corneal surface disease and dry eye disease. Nonmalignant ocular surface disease and dry eye disease.
(F)Ocular pain, nonsurgical in cause except when comanaged with the treating physician and surgeon, associated with conditions optometrists are authorized to treat.
(G)Hypotrichosis and blepharitis.
(H)Pursuant to subdivision (e), 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 (d).
(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 or prescribe, including for rational off-label purposes, all of the following therapeutic pharmaceutical agents:
(1)Topical pharmaceutical agents for the examination of the human eye or eyes for any disease or pathological condition, including, but not limited to, 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 patients condition worsens 21 days after diagnosis.
(4)Topical and oral anti-inflammatories.
(5)Topical antibiotic agents.
(6)Topical hyperosmotics.
(7)Topical and oral antiglaucoma agents pursuant to the certification process defined in subdivision (e).
(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.
(12)Topical and oral antiviral medication for the medical treatment of herpes simplex viral keratitis, herpes simplex viral conjunctivitis, periocular herpes simplex viral dermatitis, varicella zoster viral keratitis, varicella zoster viral conjunctivitis, and periocular varicella zoster viral dermatitis.
(13)Oral analgesics that are not controlled substances.
(14)Codeine with compounds and compounds, hydrocodone with compounds compound, and tramadol 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.
(15)Additional therapeutic pharmaceutical agents pursuant to subdivision (f).
(d)An optometrist who is certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 may also perform all of the following: following procedures:
(1)Corneal scraping with cultures.
(2)Debridement of corneal epithelia.
(3)Mechanical epilation.
(4)Collection of blood by skin puncture or 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 the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA) (42 U.S.C. Sec. 263a; Public Law 100-578) 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)Skin testing to diagnose ocular allergies, limited to the superficial layer of the skin.
(12)Punctal occlusion by plugs, excluding laser, diathermy, cryotherapy, or other means constituting surgery as defined in this chapter.
(13)The use or prescription of diagnostic or therapeutic contact lenses, including lenses or devices that incorporate a medication or therapy the optometrist is certified to prescribe or provide.
(14)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.
(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 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.
(16)Use of any topical or oral therapeutic pharmaceutical agent or noninvasive medical device or technology authorized pursuant to subdivision (f).
(e)An optometrist certified pursuant to Section 3041.3 shall be certified 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 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 who are not described in paragraph (2) or (3), submission of proof of satisfactory completion of the requirements for certification established by the board.
(f)(1)Any topical or oral therapeutic pharmaceutical agent, which is not a controlled substance, or noninvasive medical device or technology whose use does not constitute surgery, as defined in subdivision (i), that is not expressly authorized for use or prescription by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 shall be deemed to be authorized if it has received a United States Food and Drug Administration approved indication for the diagnosis or treatment of a condition authorized by this chapter. A licensee shall successfully complete any clinical training imposed by a related manufacturer prior to using any of those therapeutic pharmaceutical agents or noninvasive medical devices or technologies.
(2)Any other topical or oral therapeutic pharmaceutical agent, which is not a controlled substance, or noninvasive medical device or technology whose use does not constitute surgery, as defined in subdivision (i), that is not expressly authorized for use or prescription by an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 and does not meet the requirements in paragraph (1) shall be deemed authorized if approved by the board through regulation for the rational treatment of a condition authorized by this chapter. Any regulation under this paragraph shall require a licensee to successfully complete an appropriate amount of clinical training to qualify to use each topical or oral therapeutic pharmaceutical agent or noninvasive medical device or technology approved by the board pursuant to this paragraph.
(3)The subdivision shall not be construed to authorize either of the following:
(A)Injections administered for cosmetic effect.
(B)The performance of blepharoplasty or other cosmetic surgery procedure that reshapes the normal structures of the body in order to improve appearance and self-esteem.
(f)(g)(1)An optometrist certified pursuant to Section 3014.3 shall be certified for the administration of immunizations after the optometrist meets all of the following requirements:
(A)Completes an immunization training program endorsed by the federal Centers for Disease Control and Prevention (CDC) that, at a minimum, includes hands-on injection technique, clinical evaluation of indications and contradications of vaccines, and the recognition and treatment of emergency reactions to vaccines, and maintains that training.
(B)Is certified in basic life support.
(C)Complies with all state and federal recordkeeping and reporting requirements, including providing documentation to the patients primary care provided and entering information in the appropriate immunization registry designated by the immunization branch of the State Department of Public Health.
(D)Applies for an immunization certificate on a board-approved form.
(2)For the purposes of this section, immunization means the administration of immunizations for influenza, herpes zoster virus, and pneumococcus in compliance with individual Advisory Committee on Immunization Practices (ACIP) vaccine recommendations published by the CDC for persons 18 years of age or older.
(g)(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.
(h)(i)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 paragraphs (1) to (15), inclusive, of subdivision (d). This subdivision does not limit an optometrists authority to utilize diagnostic laser and ultrasound technology within his or her scope of practice.
(i)(j)An optometrist licensed under this chapter is subject to the provisions of Section 2290.5 for purposes of practicing telehealth.
(j)(k)For purposes of this chapter, glaucoma means either of the following:
(1)All primary open-angle glaucoma.
(2)Exfoliation and pigmentary glaucoma.
(3)(A)Steroid induced glaucoma.
(B)If an optometrist treats a patient for steroid induced glaucoma the optometrist shall promptly notify the prescriber of the steroid medication if the prescriber did not refer the patient to the optometrist for treatment.
(k)(l)For purposes of this chapter, adnexa means ocular adnexa.
(l)(m)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. 3.Section 3041.1 of the Business and Professions Code is amended to read:3041.1.Diagnosing An optometrist 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 optometristss scope of practice. Consultations, referrals, and notifications required by this section shall be documented in the patient record.
SEC. 4.Section 3041.2 of the Business and Professions Code is amended to read:3041.2.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 educational and examination requirements shall be a condition for the issuance of an original optometrist license or certifications pursuant to this chapter.
SEC. 5.Section 3041.3 of the Business and Professions Code is amended to read: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) and (d) 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 accredited ophthalmology residency program 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 ophthalmologists office or an optometric clinic. The training received during the preceptorship shall be on the diagnosis, treatment, and management of ocular and systemic disease. The preceptor shall certify completion of the preceptorship using a form approved by the board. Authorization for the ophthalmologist to serve as a preceptor shall be granted by an accredited school of optometry in California. A preceptor shall be a board- certified ophthalmologist in California licensed by and in good standing with the Medical Board of California. 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 Optometrys 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 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 requirements 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 Optometrys national board examination, or its equivalent, as determined by the board.(2)Of the total clinical training required by a school of optometrys curriculum, successfully completed at least 65 of those hours on the diagnosis, treatment, and management of ocular and systemic disease.(3)Is certified by an accredited school of optometry as competent in the diagnosis, treatment, and management of ocular and 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 graduated 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 optometrists education or training under this subdivision.SEC. 5.Section 3041.3 of the Business and Professions Code is amended to read: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) and (e) (d) 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 therapeutic pharmaceutical agents (TPA) certification 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)Completes a preceptorship of no less than 65 hours, during a period of not less than two months nor more than one year, with either a TPA-certified optometrist in good standing or a physician and surgeon board-certified in ophthalmology in good standing. The training received during the preceptorship shall be on the diagnosis, treatment, and management of ocular and systemic disease. The preceptor shall certify completion of the preceptorship using a form approved by the board. 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 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.
(2)Successfully completes a minimum of 100 hours of directed and accredited education in ocular and systemic diseases within two years prior to meeting the requirements of paragraph (1).
(3)Passes the National Board of Examiners in Optometrys 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.
(c)The board shall grant a therapeutic pharmaceutical agents certification 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 passes all sections of the National Board of Examiners in Optometrys national board examination or its equivalent, as determined by the State Board of Optometry.
(d)The board shall grant a therapeutic pharmaceutical agents certification 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 granted a therapeutic pharmaceutical agents certification.
(1)In order to obtain a therapeutic pharmaceutical agents certification, 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 therapeutic pharmaceutical agents certification, 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 therapeutic pharmaceutical agents certification, 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 therapeutic pharmaceutical agents certification, 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 optometrists education or training under this subdivision.
SEC. 6.Section 3056 of the Business and Professions Code is amended to read:3056.(a)The board may issue a license to practice optometry to a person who meets all of the following qualifications:
(1)Has a degree as a doctor of optometry issued by an accredited school or college of optometry.
(2)Is currently licensed in another state.
(3)Is currently a full-time faculty member of an accredited California school or college of optometry and has served in that capacity for a period of at least five continuous years.
(4)Has attained, at an accredited California school or college of optometry, the academic rank of professor, associate professor, or clinical professor, except that the status of adjunct or affiliated faculty member shall not be deemed sufficient.
(5)Has successfully passed the boards jurisprudence examination.
(6)Is in good standing, with no past or pending malpractice awards or judicial or administrative actions.
(7)Has met the minimum continuing education requirements set forth in Section 3059 for the current and preceding year.
(8)Has met the requirements of Section 3041.3 regarding the use of therapeutic pharmaceutical agents under subdivision (d) of Section 3041.
(9)Has never had his or her license to practice optometry revoked or suspended.
(10)(A)Is not subject to denial based on any of the grounds listed in Section 480.
(B)Is not currently required to register as a sex offender pursuant to Section 290 of the Penal Code.
(11)Pays an application fee in an amount equal to the application fee prescribed by the board pursuant to Section 3152.
(12)Files an application on a form prescribed by the board.
(b)Any license issued pursuant to this section shall expire as provided in Section 3146, and may be renewed as provided in this chapter, subject to the same conditions as other licenses issued under this chapter.
(c)The term in good standing, as used in this section, means that a person under this section:
(1)Is not currently under investigation nor has been charged with an offense for any act substantially related to the practice of optometry by any public agency, nor entered into any consent agreement or subject to an administrative decision that contains conditions placed by an agency upon a persons professional conduct or practice, including any voluntary surrender of license, nor been the subject of an adverse judgment resulting from the practice of optometry that the board determines constitutes evidence of a pattern of incompetence or negligence.
(2)Has no physical or mental impairment related to drugs or alcohol, and has not been found mentally incompetent by a physician so that the person is unable to undertake the practice of optometry in a manner consistent with the safety of a patient or the public.
SEC. 7.Section 3057 of the Business and Professions Code is amended to read:3057.(a)The board may issue a license to practice optometry to a person who meets all of the following requirements:
(1)Has a degree as a doctor of optometry issued by an accredited school or college of optometry.
(2)Has successfully passed the licensing examination for an optometric license in another state.
(3)Submits proof that he or she is licensed in good standing as of the date of application in every state where he or she holds a license, including compliance with continuing education requirements.
(4)Is not subject to disciplinary action as set forth in subdivision (h) of Section 3110. If the person has been subject to disciplinary action, the board shall review that action to determine if it presents sufficient evidence of a violation of this chapter to warrant the submission of additional information from the person or the denial of the application for licensure.
(5)Has furnished a signed release allowing the disclosure of information from the National Practitioner Database and, if applicable, the verification of registration status with the federal Drug Enforcement Administration. The board shall review this information to determine if it presents sufficient evidence of a violation of this chapter to warrant the submission of additional information from the person or the denial of the application for licensure.
(6)Has never had his or her license to practice optometry revoked or suspended in any state where the person holds a license.
(7)(A)Is not subject to denial of an application for licensure based on any of the grounds listed in Section 480.
(B)Is not currently required to register as a sex offender pursuant to Section 290 of the Penal Code.
(8)Has met the minimum continuing education requirements set forth in Section 3059 for the current and preceding year.
(9)Has met the certification requirements of Section 3041.3 to use therapeutic pharmaceutical agents under subdivision (d) of Section 3041.
(10)Submits any other information as specified by the board to the extent it is required for licensure by examination under this chapter.
(11)Files an application on a form prescribed by the board, with an acknowledgment by the person executed under penalty of perjury and automatic forfeiture of license, of the following:
(A)That the information provided by the person to the board is true and correct, to the best of his or her knowledge and belief.
(B)That the person has not been convicted of an offense involving conduct that would violate Section 810.
(12)Pays an application fee in an amount equal to the application fee prescribed pursuant to subdivision (a) of Section 3152.
(13)Has successfully passed the boards jurisprudence examination.
(b)If the board finds that the competency of a candidate for licensure pursuant to this section is in question, the board may require the passage of a written, practical, or clinical examination or completion of additional continuing education or coursework.
(c)In cases where the person establishes, to the boards satisfaction, that he or she has been displaced by a federally declared emergency and cannot relocate to his or her state of practice within a reasonable time without economic hardship, the board may reduce or waive the fees required by paragraph (12) of subdivision (a).
(d)Any license issued pursuant to this section shall expire as provided in Section 3146, and may be renewed as provided in this chapter, subject to the same conditions as other licenses issued under this chapter.
(e)The term in good standing, as used in this section, means that a person under this section:
(1)Is not currently under investigation nor has been charged with an offense for any act substantially related to the practice of optometry by any public agency, nor entered into any consent agreement or subject to an administrative decision that contains conditions placed by an agency upon a persons professional conduct or practice, including any voluntary surrender of license, nor been the subject of an adverse judgment resulting from the practice of optometry that the board determines constitutes evidence of a pattern of incompetence or negligence.
(2)Has no physical or mental impairment related to drugs or alcohol, and has not been found mentally incompetent by a licensed psychologist or licensed psychiatrist so that the person is unable to undertake the practice of optometry in a manner consistent with the safety of a patient or the public.
SEC. 8.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 licensees 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 bloodborne 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 bloodborne pathogens in health care settings. As necessary, the board may consult with the Medical Board of California, the California Board of Podiatric Medicine, the Board of Registered Nursing, and the Board of Vocational Nursing and Psychiatric Technicians of the State of California, 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 patients 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 and surgeon if an examination of the eyes indicates a substantial likelihood of any pathology that requires the attention of that physician and surgeon.
SEC. 9.Section 3152 of the Business and Professions Code is amended to read:3152.The amounts of fees and penalties prescribed by this chapter shall be established by the board in amounts not greater than those specified in the following schedule:
(a)The fee for applicants applying for a license shall not exceed two hundred seventy-five dollars ($275).
(b)The fee for renewal of an optometric license shall not exceed five hundred dollars ($500).
(c)The annual fee for the renewal of a branch office license shall not exceed seventy-five dollars ($75).
(d)The fee for a branch office license shall not exceed seventy-five dollars ($75).
(e)The penalty for failure to pay the annual fee for renewal of a branch office license shall not exceed twenty-five dollars ($25).
(f)The fee for issuance of a license or upon change of name authorized by law of a person holding a license under this chapter shall not exceed twenty-five dollars ($25).
(g)The delinquency fee for renewal of an optometric license shall not exceed fifty dollars ($50).
(h)The application fee for a certificate to perform lacrimal irrigation and dilation shall not exceed fifty dollars ($50).
(i)The application fee for a certificate to treat glaucoma shall not exceed fifty dollars ($50).
(j)The fee for approval of a continuing education course shall not exceed one hundred dollars ($100).
(k)The fee for issuance of a statement of licensure shall not exceed forty dollars ($40).
(l)The fee for biennial renewal of a statement of licensure shall not exceed forty dollars ($40).
(m)The delinquency fee for renewal of a statement of licensure shall not exceed twenty dollars ($20).
(n)The application fee for a fictitious name permit shall not exceed fifty dollars ($50).
(o)The renewal fee for a fictitious name permit shall not exceed fifty dollars ($50).
(p)The delinquency fee for renewal of a fictitious name permit shall not exceed twenty-five dollars ($25).
(q)The fee for a retired license shall not exceed twenty-five dollars ($25).
(r)The fee for a retired license with volunteer designation shall not exceed fifty dollars ($50).
(s)The biennial renewal fee for a retired license with volunteer designation shall not exceed fifty dollars ($50).
(t)The application fee for a certificate to administer immunizations shall not exceed fifty dollars ($50).
SEC. 10.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
(a)As used in this chapter, laboratory director means any person who is any of the following:
(1)A duly licensed physician and surgeon.
(2)Only for purposes of a clinical laboratory test or examination classified as waived, is any of the following:
(A)A duly licensed clinical laboratory scientist.
(B)A duly licensed limited clinical laboratory scientist.
(C)A duly licensed naturopathic doctor.
(D)A duly licensed optometrist serving as the director of a laboratory that only performs clinical laboratory tests authorized in paragraph (10) of subdivision (e) (d) of Section 3041.
(3)Licensed to direct a clinical laboratory under this chapter.
(b)(1)A person defined in paragraph (1) or (3) of subdivision (a) who is identified as the CLIA laboratory director of a laboratory that performs clinical laboratory tests classified as moderate or high complexity shall also meet the laboratory director qualifications under CLIA for the type and complexity of tests being offered by the laboratory.
(2)As used in this subdivision, CLIA laboratory director means the person identified as the laboratory director on the CLIA certificate issued to the laboratory by the federal Centers for Medicare and Medicaid Services (CMS).
(c)The laboratory director, if qualified under CLIA, may perform the duties of the technical consultant, technical supervisor, clinical consultant, general supervisor, and testing personnel, or delegate these responsibilities to persons qualified under CLIA. If the laboratory director reapportions performance of those responsibilities or duties, he or she shall remain responsible for ensuring that all those duties and responsibilities are properly performed.
(d)(1)The laboratory director is responsible for the overall operation and administration of the clinical laboratory, including administering the technical and scientific operation of a clinical laboratory, the selection and supervision of procedures, the reporting of results, and active participation in its operations to the extent necessary to ensure compliance with this act and CLIA. He or she shall be responsible for the proper performance of all laboratory work of all subordinates and shall employ a sufficient number of laboratory personnel with the appropriate education and either experience or training to provide appropriate consultation, properly supervise and accurately perform tests, and report test results in accordance with the personnel qualifications, duties, and responsibilities described in CLIA and this chapter.
(2)Where a point-of-care laboratory testing device is utilized and provides results for more than one analyte, the testing personnel may perform and report the results of all tests ordered for each analyte for which he or she has been found by the laboratory director to be competent to perform and report.
(e)As part of the overall operation and administration, the laboratory director of a registered laboratory shall document the adequacy of the qualifications (educational background, training, and experience) of the personnel directing and supervising the laboratory and performing the laboratory test procedures and examinations. In determining the adequacy of qualifications, the laboratory director shall comply with any regulations adopted by the department that specify the minimum qualifications for personnel, in addition to any CLIA requirements relative to the education or training of personnel.
(f)As part of the overall operation and administration, the laboratory director of a licensed laboratory shall do all of the following:
(1)Ensure that all personnel, prior to testing biological specimens, have the appropriate education and experience, receive the appropriate training for the type and complexity of the services offered, and have demonstrated that they can perform all testing operations reliably to provide and report accurate results. In determining the adequacy of qualifications, the laboratory director shall comply with any regulations adopted by the department that specify the minimum qualifications for, and the type of procedures that may be performed by, personnel in addition to any CLIA requirements relative to the education or training of personnel. Any regulations adopted pursuant to this section that specify the type of procedure that may be performed by testing personnel shall be based on the skills, knowledge, and tasks required to perform the type of procedure in question.
(2)Ensure that policies and procedures are established for monitoring individuals who conduct preanalytical, analytical, and postanalytical phases of testing to ensure that they are competent and maintain their competency to process biological specimens, perform test procedures, and report test results promptly and proficiently, and, whenever necessary, identify needs for remedial training or continuing education to improve skills.
(3)Specify in writing the responsibilities and duties of each individual engaged in the performance of the preanalytic, analytic, and postanalytic phases of clinical laboratory tests or examinations, including which clinical laboratory tests or examinations the individual is authorized to perform, whether supervision is required for the individual to perform specimen processing, test performance, or results reporting, and whether consultant, supervisor, or director review is required prior to the individual reporting patient test results.
(g)The competency and performance of staff of a licensed laboratory shall be evaluated and documented by the laboratory director, or by a person who qualifies as a technical consultant or a technical supervisor under CLIA depending on the type and complexity of tests being offered by the laboratory.
(1)The procedures for evaluating the competency of the staff shall include, but are not limited to, all of the following:
(A)Direct observations of routine patient test performance, including patient preparation, if applicable, and specimen handling, processing, and testing.
(B)Monitoring the recording and reporting of test results.
(C)Review of intermediate test results or worksheets, quality control records, proficiency testing results, and preventive maintenance records.
(D)Direct observation of performance of instrument maintenance and function checks.
(E)Assessment of test performance through testing previously analyzed specimens, internal blind testing samples, or external proficiency testing samples.
(F)Assessment of problem solving skills.
(2)Evaluation and documentation of staff competency and performance shall occur at least semiannually during the first year an individual tests biological specimens. Thereafter, evaluations shall be performed at least annually unless test methodology or instrumentation changes, in which case, prior to reporting patient test results, the individuals performance shall be reevaluated to include the use of the new test methodology or instrumentation.
(h)The laboratory director of each clinical laboratory of an acute care hospital shall be a physician and surgeon who is a qualified pathologist, except as follows:
(1)If a qualified pathologist is not available, a physician and surgeon or a clinical laboratory bioanalyst qualified as a laboratory director under subdivision (a) may direct the laboratory. However, a qualified pathologist shall be available for consultation at suitable intervals to ensure high-quality service.
(2)If there are two or more clinical laboratories of an acute care hospital, those additional clinical laboratories that are limited to the performance of blood gas analysis, blood electrolyte analysis, or both, may be directed by a physician and surgeon qualified as a laboratory director under subdivision (a), irrespective of whether a pathologist is available.
As used in this subdivision, a qualified pathologist is a physician and surgeon certified or eligible for certification in clinical or anatomical pathology by the American Board of Pathology or the American Osteopathic Board of Pathology.
(i)Subdivision (h) does not apply to any director of a clinical laboratory of an acute care hospital acting in that capacity on or before January 1, 1988.
(j)A laboratory director may serve as the director of up to the maximum number of laboratories stipulated by CLIA, as defined under Section 1202.5.
SEC. 2.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. eye disease.
(F)Ocular pain, nonsurgical in cause except when comanaged with the treating physician and surgeon, associated with conditions optometrists are authorized to treat.
(G)Hypotrichosis and blepharitis.
(G)(H)Pursuant to subdivision (f), (e), 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). (d).
(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 Topical pharmaceutical agents as described in paragraph (5) of subdivision (a), as well as topical miotics. for the examination of the human eye or eyes for any disease or pathological condition, including, but not limited to, 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 patients 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 patients condition worsens 72 hours after the diagnosis, or if the patients 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 patients condition worsens 72 hours after diagnosis.(C)Traumatic iritis, an optometrist shall consult with an ophthalmologist or appropriate physician and surgeon if the patients condition worsens 72 hours after diagnosis and shall refer the patient to an ophthalmologist or appropriate physician and surgeon if the patients 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). (e).
(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 patients diabetes in developing the glaucoma treatment plan and shall inform the physician in writing of any changes in the patients 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 dermatitis, 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 patients condition has not improved seven days after diagnosis, the optometrist shall refer the patient to an ophthalmologist. If a patients 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 patients condition worsens seven days after diagnosis, the optometrist shall consult with an ophthalmologist. If the patients 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 patients file of the information provided to the ophthalmologist, the ophthalmologists response, and any other relevant information. Upon the consulting ophthalmologists request and with the patients consent, the optometrist shall furnish a copy of the record to the ophthalmologist.(e)(d)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 Collection of blood by skin puncture or 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 the federal Clinical Laboratory Improvement Amendments of 1988 (CLIA) (42 U.S.C. Sec. 263a; Public Law 100-578) 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)Skin testing to diagnose ocular allergies, limited to the superficial layer of the skin.
(11)(12)Punctal occlusion by plugs, excluding laser, diathermy, cryotherapy, or other means constituting surgery as defined in this chapter.
(12)(13)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)(14)Removal of foreign bodies from the cornea, eyelid, and conjunctiva with any appropriate instrument other than a scalpel or needle. scalpel. Corneal foreign bodies shall be nonperforating, be no deeper than the midstroma, and require no surgical repair upon removal.
(14)(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 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(e)An optometrist certified pursuant to Section 3041.3 shall be certified 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)(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. board.
(5)(4)For licensees who graduated from an accredited school of optometry on or before May 1, 2008, and who are not described in paragraph (2), (3), or (4), (2) or (3), submission of proof of satisfactory completion of the requirements for certification established by the board pursuant to Section 3041.10. board.
(f)(1)An optometrist certified pursuant to Section 3014.3 shall be certified for the administration of immunizations after the optometrist meets all of the following requirements:
(A)Completes an immunization training program endorsed by the federal Centers for Disease Control and Prevention (CDC) that, at a minimum, includes hands-on injection technique, clinical evaluation of indications and contradications of vaccines, and the recognition and treatment of emergency reactions to vaccines, and maintains that training.
(B)Is certified in basic life support.
(C)Complies with all state and federal recordkeeping and reporting requirements, including providing documentation to the patients primary care provided and entering information in the appropriate immunization registry designated by the immunization branch of the State Department of Public Health.
(2)For the purposes of this section, immunization means the administration of immunizations for influenza, herpes zoster virus, and pneumococcus in compliance with individual Advisory Committee on Immunization Practices (ACIP) vaccine recommendations published by the CDC for persons 18 years of age or older.
(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 (d). This subdivision does not limit an optometrists 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.
SEC. 3.Section 3041.1 of the Business and Professions Code is amended to read:3041.1.With respect to the practices set forth in subdivisions (b), (d), and (e) of Section 3041, optometrists diagnosing 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 optometristss scope of practice.
SEC. 4.Section 3041.2 of the Business and Professions Code is amended to read: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. this chapter. 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. or certifications pursuant to this chapter.
(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 3041.3 of the Business and Professions Code is amended to read: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) and (e) (d) 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 (TPA) certification 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 accredited ophthalmology residency program in California.
(1)(2)Completes a preceptorship of no less than 65 hours, during a period of not less than two months nor more than one year, with either a TPA-certified optometrist in good standing or a physician and surgeon board-certified in ophthalmology in good standing. in either an ophthalmologists office or an optometric clinic. The training received during the preceptorship shall be on the diagnosis, treatment, and management of ocular and systemic disease. The preceptor shall certify completion of the preceptorship using a form approved by the board. 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. Authorization for the ophthalmologist to serve as a preceptor shall be granted by an accredited school of optometry in California. A preceptor shall be a board- certified ophthalmologist in California licensed by and in good standing with the Medical Board of California. 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.
(2)(3)Successfully completes a minimum of 100 20 hours of directed and accredited education in ocular and systemic diseases within two years prior to meeting the requirements of paragraph (1). self-directed education.
(3)(4)Passes the National Board of Examiners in Optometrys 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 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 requirements 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 certification 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 passes all sections of the National Board of Examiners in Optometrys national board examination or its equivalent, as determined by the State Board of Optometry. meets all of the following requirements:
(1)Passes the National Board of Examiners in Optometrys national board examination, or its equivalent, as determined by the board.
(2)Of the total clinical training required by a school of optometrys curriculum, successfully completed at least 65 of those hours on the diagnosis, treatment, and management of ocular and systemic disease.
(3)Is certified by an accredited school of optometry as competent in the diagnosis, treatment, and management of ocular and 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 certification 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 granted a certified to use therapeutic pharmaceutical agents certification. agents.
(1)In order to obtain a certificate to use therapeutic pharmaceutical agents certification, 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 certification, 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 graduated 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 certification, 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 certification, 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 optometrists education or training under this subdivision.
SEC. 6.Section 3056 of the Business and Professions Code is amended to read:3056.(a)The board may issue a license to practice optometry to a person who meets all of the following qualifications:
(1)Has a degree as a doctor of optometry issued by an accredited school or college of optometry.
(2)Is currently licensed in another state.
(3)Is currently a full-time faculty member of an accredited California school or college of optometry and has served in that capacity for a period of at least five continuous years.
(4)Has attained, at an accredited California school or college of optometry, the academic rank of professor, associate professor, or clinical professor, except that the status of adjunct or affiliated faculty member shall not be deemed sufficient.
(5)Has successfully passed the boards jurisprudence examination.
(6)Is in good standing, with no past or pending malpractice awards or judicial or administrative actions.
(7)Has met the minimum continuing education requirements set forth in Section 3059 for the current and preceding year.
(8)Has met the requirements of Section 3041.3 regarding the use of therapeutic pharmaceutical agents under subdivision (e) (d) of Section 3041.
(9)Has never had his or her license to practice optometry revoked or suspended.
(10)(A)Is not subject to denial based on any of the grounds listed in Section 480.
(B)Is not currently required to register as a sex offender pursuant to Section 290 of the Penal Code.
(11)Pays an application fee in an amount equal to the application fee prescribed by the board pursuant to Section 3152.
(12)Files an application on a form prescribed by the board.
(b)Any license issued pursuant to this section shall expire as provided in Section 3146, and may be renewed as provided in this chapter, subject to the same conditions as other licenses issued under this chapter.
(c)The term in good standing, as used in this section, means that a person under this section:
(1)Is not currently under investigation nor has been charged with an offense for any act substantially related to the practice of optometry by any public agency, nor entered into any consent agreement or subject to an administrative decision that contains conditions placed by an agency upon a persons professional conduct or practice, including any voluntary surrender of license, nor been the subject of an adverse judgment resulting from the practice of optometry that the board determines constitutes evidence of a pattern of incompetence or negligence.
(2)Has no physical or mental impairment related to drugs or alcohol, and has not been found mentally incompetent by a physician so that the person is unable to undertake the practice of optometry in a manner consistent with the safety of a patient or the public.
SEC. 7.Section 3057 of the Business and Professions Code is amended to read:3057.(a)The board may issue a license to practice optometry to a person who meets all of the following requirements:
(1)Has a degree as a doctor of optometry issued by an accredited school or college of optometry.
(2)Has successfully passed the licensing examination for an optometric license in another state.
(3)Submits proof that he or she is licensed in good standing as of the date of application in every state where he or she holds a license, including compliance with continuing education requirements.
(4)Is not subject to disciplinary action as set forth in subdivision (h) of Section 3110. If the person has been subject to disciplinary action, the board shall review that action to determine if it presents sufficient evidence of a violation of this chapter to warrant the submission of additional information from the person or the denial of the application for licensure.
(5)Has furnished a signed release allowing the disclosure of information from the National Practitioner Database and, if applicable, the verification of registration status with the federal Drug Enforcement Administration. The board shall review this information to determine if it presents sufficient evidence of a violation of this chapter to warrant the submission of additional information from the person or the denial of the application for licensure.
(6)Has never had his or her license to practice optometry revoked or suspended in any state where the person holds a license.
(7)(A)Is not subject to denial of an application for licensure based on any of the grounds listed in Section 480.
(B)Is not currently required to register as a sex offender pursuant to Section 290 of the Penal Code.
(8)Has met the minimum continuing education requirements set forth in Section 3059 for the current and preceding year.
(9)Has met the certification requirements of Section 3041.3 to use therapeutic pharmaceutical agents under subdivision (e) (d) of Section 3041.
(10)Submits any other information as specified by the board to the extent it is required for licensure by examination under this chapter.
(11)Files an application on a form prescribed by the board, with an acknowledgment by the person executed under penalty of perjury and automatic forfeiture of license, of the following:
(A)That the information provided by the person to the board is true and correct, to the best of his or her knowledge and belief.
(B)That the person has not been convicted of an offense involving conduct that would violate Section 810.
(12)Pays an application fee in an amount equal to the application fee prescribed pursuant to subdivision (a) of Section 3152.
(13)Has successfully passed the boards jurisprudence examination.
(b)If the board finds that the competency of a candidate for licensure pursuant to this section is in question, the board may require the passage of a written, practical, or clinical examination or completion of additional continuing education or coursework.
(c)In cases where the person establishes, to the boards satisfaction, that he or she has been displaced by a federally declared emergency and cannot relocate to his or her state of practice within a reasonable time without economic hardship, the board may reduce or waive the fees required by paragraph (12) of subdivision (a).
(d)Any license issued pursuant to this section shall expire as provided in Section 3146, and may be renewed as provided in this chapter, subject to the same conditions as other licenses issued under this chapter.
(e)The term in good standing, as used in this section, means that a person under this section:
(1)Is not currently under investigation nor has been charged with an offense for any act substantially related to the practice of optometry by any public agency, nor entered into any consent agreement or subject to an administrative decision that contains conditions placed by an agency upon a persons professional conduct or practice, including any voluntary surrender of license, nor been the subject of an adverse judgment resulting from the practice of optometry that the board determines constitutes evidence of a pattern of incompetence or negligence.
(2)Has no physical or mental impairment related to drugs or alcohol, and has not been found mentally incompetent by a licensed psychologist or licensed psychiatrist so that the person is unable to undertake the practice of optometry in a manner consistent with the safety of a patient or the public.
SEC. 8.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 licensees 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 bloodborne 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 bloodborne pathogens in health care settings. As necessary, the board may consult with the Medical Board of California, the California Board of Podiatric Medicine, the Board of Registered Nursing, and the Board of Vocational Nursing and Psychiatric Technicians, Technicians of the State of California, 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 patients 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 in either of the following circumstances:
(1)Where and surgeon if an examination of the eyes indicates a substantial likelihood of any pathology that requires the attention of that physician. physician and surgeon.
(2)As required by subdivision (c) of Section 3041.SEC. 9.Section 3152 of the Business and Professions Code is amended to read:3152.The amounts of fees and penalties prescribed by this chapter shall be established by the board in amounts not greater than those specified in the following schedule:
(a)The fee for applicants applying for a license shall not exceed two hundred seventy-five dollars ($275).
(b)The fee for renewal of an optometric license shall not exceed five hundred dollars ($500).
(c)The annual fee for the renewal of a branch office license shall not exceed seventy-five dollars ($75).
(d)The fee for a branch office license shall not exceed seventy-five dollars ($75).
(e)The penalty for failure to pay the annual fee for renewal of a branch office license shall not exceed twenty-five dollars ($25).
(f)The fee for issuance of a license or upon change of name authorized by law of a person holding a license under this chapter shall not exceed twenty-five dollars ($25).
(g)The delinquency fee for renewal of an optometric license shall not exceed fifty dollars ($50).
(h)The application fee for a certificate to perform lacrimal irrigation and dilation shall not exceed fifty dollars ($50).
(i)The application fee for a certificate to treat glaucoma shall not exceed fifty dollars ($50).
(j)The fee for approval of a continuing education course shall not exceed one hundred dollars ($100).
(k)The fee for issuance of a statement of licensure shall not exceed forty dollars ($40).
(l)The fee for biennial renewal of a statement of licensure shall not exceed forty dollars ($40).
(m)The delinquency fee for renewal of a statement of licensure shall not exceed twenty dollars ($20).
(n)The application fee for a fictitious name permit shall not exceed fifty dollars ($50).
(o)The renewal fee for a fictitious name permit shall not exceed fifty dollars ($50).
(p)The delinquency fee for renewal of a fictitious name permit shall not exceed twenty-five dollars ($25).
(q)The fee for a retired license shall not exceed twenty-five dollars ($25).
(r)The fee for a retired license with volunteer designation shall not exceed fifty dollars ($50).
(s)The biennial renewal fee for a retired license with volunteer designation shall not exceed fifty dollars ($50).
(t)The application fee for a certificate to administer immunizations shall not exceed fifty dollars ($50).
SEC. 10.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB 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 XIIIB of the California Constitution.
SECTION 1.Section 3093 of the Business and Professions Code is amended to read:3093.(a)Before setting aside the revocation or suspension of any optometrist license, the board may require the applicant to pass the regular examination given to applicants for an optometrist license.(b)If the board requires an applicant to pass the regular examination pursuant to subdivision (a), the board shall do both of the following:(1)Notify the applicant of the timeframe to take and pass the examination.(2)Provide the applicant with a minimum 30 days notice before an available examination that the applicant is required to take the examination.(a)Before setting aside the revocation or suspension of any optometrist license, the board may require the applicant to pass the regular examination given for to applicants for an optometrist license.
(b)If the board requires an applicant to pass the regular examination pursuant to subdivision (a), the board shall do both of the following:
(1)Notify the applicant of the timeframe to take and pass the examination.
(2)Provide the applicant with a minimum 30 days notice before an available examination that the applicant is required to take the examination.
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Date
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Status
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|---|---|
| Oct 7, 2017 | Chaptered by Secretary of State - Chapter 549, Statutes of 2017. |
| Oct 7, 2017 | Approved by the Governor. |
| Sep 27, 2017 | Enrolled and presented to the Governor at 4 p.m. |
| Sep 16, 2017 | Senate amendments concurred in. To Engrossing and Enrolling. |
| Sep 14, 2017 | In Assembly. Concurrence in Senate amendments pending. |
| Sep 13, 2017 | Read third time. Passed. Ordered to the Assembly. |
| Sep 11, 2017 | Read second time. Ordered to third reading. |
| Sep 8, 2017 | Read third time and amended. Ordered to second reading. |
| Aug 22, 2017 | Read second time. Ordered to third reading. |
| Aug 21, 2017 | From committee: Be ordered to second reading pursuant to Senate Rule 28.8. |
| Jul 11, 2017 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 9. Noes 0.) (July 10). Re-referred to Com. on APPR. |
| Jul 5, 2017 | From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on B., P. & E.D. |
| Jun 27, 2017 | In committee: Set, first hearing. Hearing canceled at the request of author. |
| Jun 12, 2017 | In committee: Hearing postponed by committee. |
| Jun 8, 2017 | Referred to Com. on B., P. & E.D. |
| May 30, 2017 | In Senate. Read first time. To Com. on RLS. for assignment. |
| May 30, 2017 | Read third time. Passed. Ordered to the Senate. (Ayes 74. Noes 0. Page 1795.) |
| May 25, 2017 | Read second time. Ordered to third reading. |
| May 24, 2017 | From committee: Do pass. (Ayes 17. Noes 0.) (May 24). |
| May 3, 2017 | Re-referred to Com. on APPR. |
| May 2, 2017 | Read second time and amended. |
| Apr 26, 2017 | From committee chair, with author's amendments: Amend, and re-refer to Com. on B. & P. Read second time and amended. |
| May 1, 2017 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 12. Noes 0.) (April 25). |
| Feb 27, 2017 | Referred to Com. on B. & P. |
| Feb 14, 2017 | From printer. May be heard in committee March 16. |
| Feb 13, 2017 | Read first time. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Sep 16, 2017 | AB 443 SALAS Concurrence in Senate Amendments | Assembly Floor |
Passed |
|
| Sep 13, 2017 | Assembly 3rd Reading AB443 Salas By Hill | Senate Floor |
Passed |
|
| Jul 10, 2017 | Do pass, but first be re-referred to the Committee on [Appropriations] | Senate Standing Committee on Business, Professions and Economic Development |
Passed |
|
| May 30, 2017 | AB 443 SALAS Assembly Third Reading | Assembly Floor |
Passed |
|
| May 24, 2017 | Do pass. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 25, 2017 | Do pass as amended and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Business and Professions |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| A Voice for Choice Advocacy | ** Against | Sep 11, 2017 |
| Aaron Read & Associates | * Support | May 24, 2017 |
| California Academy Of Eye Physicians And Surgeons | * Support | Jul 10, 2017 |
| California Optometric Association | ** Support | Sep 11, 2017 |
| Californian Medical Association | * Support | May 24, 2017 |
| Medical Board of California | ** Against | Sep 11, 2017 |
| National Vaccine Information Center | ** Against | Sep 11, 2017 |
| Numerous individuals | ** Against | Sep 11, 2017 |
| VSP Vision Care | ** Support | Sep 11, 2017 |
CONCURRENCE IN SENATE AMENDMENTS
CSA1 Bill Id:AB 443
Author:(Salas)
As Amended Ver:September 8, 2017
Majority vote
ASSEMBLY: | 74-0 | (May 30, 2017) | SENATE: | 40-0 | (September 13, 2017) |
Original Committee Reference: B. & P.
SUMMARY: Makes a number of changes to the Optometry Practice Act including broadening the scope of practice for optometrists by permitting an optometrist to conduct additional procedures on their patients.
The Senate amendments authorize an optometrist who is certified to use therapeutic pharmaceutical agents to, among other things, perform skin testing to diagnose ocular allergies, to perform intravenous injection for the purpose of performing ocular angiography under specified circumstances.
EXISTING LAW:
- Establishes the Board to administer and enforce the Optometry Practice Act (Act). (Business and Professions Code (BPC) Section 3010.5)
- Defines the practice of optometry as including 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. (BPC Section 3041(a))
- Requires an optometrist to refer to an ophthalmologist a case of unilateral nongranulomatous idiopathic iritis recurring within one year of the initial occurrence. Requires an optometrist to 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. Requires an optometrist to 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. (BPC Section 3041(b)(1)(C))
- Authorizes optometrist who is certified to use TPA to also diagnose and treat the human eye or eyes, or any of its or their appendages, for Corneal surface disease. (BPC Section 3041(b)(1)(E))
- Authorizes TPA certified optometrist to use specified TPAs. (BPC Section 3041(c))
- Authorizes optometrists who are already authorized to use TPAs to prescribe therapeutic contact lenses or devices that incorporate a medication or therapy that the optometrists is certified to prescribe or provide. (BPC Section 3041(e)(12))
- Requires the Board to certify any optometrist who graduated from an accredited school of optometry before May 1, 2000, to perform lacrimal irrigation and dilation, excluding probing of the nasal lacrimal tract, on patients 12 years of age and older, after submitting proof of satisfactory completion of 10 procedures under the supervision of an ophthalmologist as confirmed by the ophthalmologist. (BPC Section 3041(d)(15))
- Lists procedures that optometrists, who are certified to use TPAs, are authorized to perform. (BPC Section 3041(d))
- Declares that optometrists diagnosing or treating eye disease will be held to the same standard of care to which physicians and surgeons and osteopathic physicians and surgeons are held. (BPC Section 3041.1)
FISCAL EFFECT: According to the May 24, 2017 analysis prepared by the Assembly Appropriations Committee, the costs to the Board of Optometry are expected to be minor and absorbable.
COMMENTS: According to a report prepared by the Center for the Health Professions at the University of California San Francisco, the number of optometrist licenses in California has declined, but the number of licensees with a secondary practice location has increased. According to the Board of Optometry, there are over 7,000 licensed optometrists in California, the largest population of optometrists in the United States. The majority of the licensed optometrists are generally concentrated in coastal counties, the Bay Area and counties in the Sacramento region. Several counties have no licensed optometrists with an address of record in those counties, and a number of other counties have ratios that indicate there is approximately one optometrist for every 10,000 people.
Optometrists' and Ophthalmologists' Education, Training, and Scope. This bill would expand the types of procedures an optometrist is authorized to perform. This would include some tasks that have been traditionally performed by ophthalmologists. As such, the current education, training and scope of each profession is outlined below.
Optometrists. Optometrists are trained to diagnose mild to severe eye problems such as serious eye infections, inflammations of the eye, trauma, foreign bodies and glaucoma. They also examine the eye for vision prescription and corrective lenses.
After completion of an undergraduate degree, optometrists complete four years of and accredited optometry college after which they are awarded the Doctor of Optometry degree. Some optometrists also undertake an optional one year non-surgical residency program to enhance their experience in a particular area. Students graduate with 2500 to 3000 patient encounters; these include a mix of post-surgical, medical and routine visits.
Optometrists who graduated from an accredited school or college of optometry on or after May 1, 2008 receive certifications to use diagnostic pharmaceutical agents (DPA); to administer TPA; to perform lacrimal irrigation and dilation (TPL); and to diagnose and treat primary open angle glaucoma (TLG). Optometrists who did not receive these certifications upon licensure may apply for these certifications after meeting the necessary requirements. In order to be certified, the optometrist must pass an exam, obtain a license to practice optometry, be certified by and accredited school of optometry that they are competent in the diagnosis, treatment and management of ocular systemic disease, and complete 10 hours of supervised practice with an ophthalmologist.
Ophthalmologists. The central focus of ophthalmology is surgery and management of complex eye diseases. An ophthalmologist specializes in the refractive, medical and surgical care of the eyes and visual system and in the prevention of disease and injury.
After obtaining an undergraduate degree, ophthalmologists complete four years at an accredited medical school and earn a Medical Degree. This is followed by a one year internship and a three or four year surgical residency. Many ophthalmologists pursue additional fellowship training in specialized areas such as retina, glaucoma, or cornea. Ophthalmologists may become certified by the American Board of Ophthalmology, which requires, serving as the primary surgeon or first assistant to the primary surgeon for a minimum of 364 eye surgeries.
Other States. Since 1997, there have been over 45 attempts in over 20 states by optometry associations to expand the scope of practice for optometrists including legislating surgery privileges. However, with the exception of Oklahoma and West Virginia, most states continue to prohibit optometrists from performing surgery, and their statutes specify that the license to practice optometry does not include the right to practice medicine. States such as Colorado and North Carolina specifically exclude surgery from their definition of the practice of optometry. Other states have statutes that delineate between laser and non-laser surgery. Optometrists are authorized to prescribe oral medications in all 50 states, they may prescribe oral steroids in 34 states, injections in 15 states and use lasers in one state.
Analysis Prepared by: Le Ondra Clark Harvey, Ph.D. / B. & P. / (916) 319-3301 FN: 0002266
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 443
:
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 9-0, 7/10/17
AYES: Hill, Fuller, Dodd, Galgiani, Glazer, Hernandez, Newman, Pan, Wilk
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 74-0, 5/30/17 - See last page for vote
DIGEST:
This bill expands the optometry scope of practice to allow for greater practice independence, the administration of specified vaccines, and the treatment of additional eye conditions, as specified.
Senate Floor Amendments of 9/8/17 incorporate changes proposed by AB 1708 (Low); authorize an optometrist who is certified to use therapeutic pharmaceutical agents to perform intravenous injection for the purpose of performing ocular angiography, as specified; rephrase the prohibition on cosmetic surgery; prohibit the performance of any clinical lab test or imaging study not otherwise authorized; prohibit the treatment of any disease or condition that could not be treated by an optometrist before January 1, 2018; and make technical changes.
Existing law:
- Establishes the California Board of Optometry (CBO) to administer and enforce the Optometry Practice Act (Act). (Business and Professions Code (BPC) § 3010.5)
- Defines the practice of optometry as including 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. (BPC § 3041(a))
- Authorizes an optometrist certified to use therapeutic pharmaceutical agents (TPA) to use specified TPA. (BPC § 3041 (c))
- Lists procedures that optometrists, who are certified to use TPA, are authorized to perform. (BPC § 3041 (d))
- Declares that optometrists diagnosing or treating eye disease will be held to the same standard of care to which physicians and surgeons and osteopathic physicians and surgeons are held. (BPC § 3041.1)
This bill:
- Adds “the provision of habilitative optometric services” to the definition of the practice of optometry.
- Removes the requirement that an optometrist must refer cases of unilateral nongranulomatous idiopathic iritis recurring within one year of the initial occurrence to an ophthalmologist.
- Removes the requirement that an optometrist must 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.
- Removes the requirement that an optometrist must 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.
- Replaces “corneal surface disease and dry eyes” with “nonmalignant ocular surface disease and dry eye disease” under conditions of the human eye an optometrist is authorized to diagnosis and treat.
- Adds hypotrichosis and blepharitis to the list of conditions of the human eye an optometrist is allowed to diagnose and treat.
- Authorizes an optometrist to prescribe, including for rational off-label use, certain TPA.
- Removes the requirement for optometrist to consult with an ophthalmologist or appropriate physician and surgeon when using steroids for certain conditions.
- Removes the requirement that an optometrist consults with the physician treating a patient’s diabetes in developing the glaucoma treatment plan, and inform the physician in writing of any changes in the patient’s glaucoma medication.
- Removes requirements for optometrist requiring consultation and/or referral to an ophthalmologist or appropriate physician and surgeon for certain conditions.
- Adds “tramadol” to the list of TPA an optometrist may use and prescribe, including for rational off-label purposes.
- Deletes the requirement that an optometrist must maintain a written record in the patient’s file of information provided to a patient’s ophthalmologist, the ophthalmologist’s response, and any other relevant information in cases for which an optometrist must consult with an ophthalmologist. Deletes the requirement that this information must be provided upon request of the ophthalmologist and with the consent of the patient.
- Authorizes an optometrist to collect blood by skin puncture for testing patients suspected of having diabetes.
- Authorizes an optometrist to do skin testing to diagnose ocular allergies, limited to the superficial layer of the skin.
- Authorizes an optometrist to do intravenous injection for the purpose of performing ocular angiography at the direction of an ophthalmologist as part of an active treatment plan in a setting where a physician and surgeon is immediately available.
- Authorizes an optometrist to use or prescribe diagnostic contact lenses.
- Authorizes an optometrist to use a needle to remove foreign bodies from the cornea, eyelid, and conjunctiva, as specified.
- Revises the qualifications to treat glaucoma in patients over 18 years of age for those licensees who substantially completed certification requirements in place between 2001 and 2008, to require submission of proof of satisfactory completion of case management requirements for glaucoma certification, as required by the CBO.
- Authorizes an optometrist, as specified, to use any topical or oral TPA which is not a controlled substance, noninvasive medical device, or technology that is not expressly authorized for use or prescription by an optometrist, if it has received a United States Food and Drug Administration approved indication for the diagnosis or treatment of a condition authorized by the Act. An optometrist shall successfully complete any clinical training imposed by a related manufacturer prior to using any of those TPA or noninvasive medical devices or technologies.
- Authorizes an optometrist, as specified, to use any other topical or oral TPA which is not a controlled substance, noninvasive medical device, or technology, that is not expressly authorized for use or prescription by an optometrist and does not meet other requirements, as specified, if approved by the CBO through regulation for the rational treatment of a condition authorized by the Act. Any regulation pursuant to this paragraph shall require a licensee to successfully complete an appropriate amount of clinical training to qualify to use each topical or oral TPA or noninvasive medical device or technology approved by the CBO pursuant to this paragraph.
- Prohibits an optometrist from using any therapeutic pharmaceutical agent, medical device, or technology involving cutting, altering, or otherwise infiltrating human tissue by any means.
- Prohibits an optometrist from performing any clinical laboratory test or imaging study not otherwise authorized, as specified.
- Prohibits an optometrist from treatment of any disease or condition that could not be treated by an optometrist before January 1, 2018.
- Authorizes an optometrist certified to use therapeutic agents and authorized to diagnose and treat specified conditions shall be certified for the administration of immunizations after the optometrist meets all of the following requirements:
- Completes an immunization training program endorsed by the federal Centers for Disease Control and Prevention (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.
- Is certified in basic life support.
- Complies with all state and federal recordkeeping and reporting requirements, including providing documentation to the patient’s primary care provided and entering information in the appropriate immunization registry designated by the immunization branch of the State Department of Public Health.
- Applies for an immunization certificate on a board-approved form.
- Defines “immunization” as the administration of immunizations for influenza, herpes zoster virus, and pneumococcus in compliance with individual Advisory Committee on Immunization Practices (ACIP) vaccine recommendations published by the CDC for persons 18 years of age or older.
- Clarifies the meaning of surgery to not include those provisions added by this bill.
- Adds “steroid induced glaucoma” to the definition of “glaucoma,” and requires an optometrist who has treated a patient for steroid induced glaucoma to promptly notify the prescriber of the steroid medication if the prescriber did not refer the patient to the optometrists for treatment.
- Requires an optometrist to 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. Consultations, referrals, and notifications required by this bill shall be documented in the patient record.
- Establishes the application fee for a certificate to administer immunizations is to not exceed $50.
- Makes non-substantive, technical, and other clarifying changes.
Background
An optometrist (Doctor of Optometry or O.D.) is an independent primary health care professional for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures, as well as identify related systemic conditions affecting the eye. ODs prescribe medications, low vision rehabilitation, vision therapy, spectacle lenses, contact lenses, and perform certain surgical procedures. Optometrists have a narrower scope of practice than do ophthalmologists, but are held to the identical standard of care for the same treatments they provide.
Optometrists are trained to diagnose mild to severe eye problems such as serious eye infections, inflammations of the eye, trauma, foreign bodies and glaucoma. They also examine the eye for vision prescription and corrective lenses. Optometrists may also pursue any of five additional state certifications to perform certain advanced procedures: use of diagnostic pharmaceutical agents; use of TPA; lacrimal irrigation and dilation for individuals over the age of 12 + TPA (TPL); diagnosis and treatment of open angle glaucoma for adults + TPA (TPG); and a combination of TPA, TPL and TPG.
Ultimately, this bill allows optometrists to utilize a greater extent of their training by expanding their scope of practice to include examination, prevention, diagnosis, and treatment of certain conditions and disorders of the visual system and the human eye.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
California Optometric Association
VSP Vision Care
Numerous Individuals
A Voice for Choice Advocacy
Medical Board of California
National Vaccine Information Center
Numerous individuals
ARGUMENTS IN SUPPORT: The California Optometric Association writes “This bill as amended reflects the agreement of stakeholders based on discussions with the California Medical Association and California Academy of Eye Physicians and Surgeons that are still ongoing. After months of productive negotiations, the only outstanding issue is the question of what additional clinical training should be required before optometrists can use lasers and perform “minor procedures” described in last year’s SB 622. All stakeholders have worked hard and negotiated in good faith to craft a bill that will eliminate arbitrary limits on the optometric profession that will help patients get the timely health care access and preventative care they deserve.”
ARGUMENTS IN OPPOSITION: The National Vaccine Information Center is opposed to the vaccine provisions. The Medical Board of California writes, “This bill expands the scope of an optometrist, but in most cases does not require any additional training, education, or collaboration with a physician. Allowing optometrists to perform these additional procedures, diagnose and treat more conditions and prescribe additional and prescribe additional topical or oral therapeutic pharmaceutical agents may result in consumer harm if the optometrist does not have the proper training, education and physician collaboration.”
ASSEMBLY FLOOR: 74-0, 5/30/17
AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bocanegra, Bonta, Brough, Burke, Caballero, Calderon, Cervantes, Chávez, Chiu, Chu, Cooley, Cooper, Cunningham, Dababneh, Daly, Flora, Fong, Frazier, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gomez, Gonzalez Fletcher, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon
NO VOTE RECORDED: Chau, Chen, Choi, Dahle, Eggman, Harper
9/11/17 9:09:22
**** END ****
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 443
:
SENATE BUS., PROF. & ECON. DEV. COMMITTEE: 9-0, 7/10/17
AYES: Hill, Fuller, Dodd, Galgiani, Glazer, Hernandez, Newman, Pan, Wilk
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
ASSEMBLY FLOOR: 74-0, 5/30/17 - See last page for vote
DIGEST:
This bill expands the optometry scope of practice to allow for greater practice independence, the administration of specified vaccines, and the treatment of additional eye conditions, as specified.
Existing law:
- Establishes the California Board of Optometry (CBO) to administer and enforce the Optometry Practice Act (Act). (Business and Professions Code (BPC) § 3010.5)
- Defines the practice of optometry as including 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. (BPC § 3041(a))
- Authorizes an optometrist certified to use therapeutic pharmaceutical agents (TPA) to use specified TPA. (BPC § 3041 (c))
- Lists procedures that optometrists, who are certified to use TPA, are authorized to perform. (BPC § 3041 (d))
- Declares that optometrists diagnosing or treating eye disease will be held to the same standard of care to which physicians and surgeons and osteopathic physicians and surgeons are held. (BPC § 3041.1)
This bill:
- Adds “the provision of habilitative optometric services” to the definition of the practice of optometry.
- Removes the requirement that an optometrist must refer cases of unilateral nongranulomatous idiopathic iritis recurring within one year of the initial occurrence to an ophthalmologist.
- Removes the requirement that an optometrist must 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.
- Removes the requirement that an optometrist must 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.
- Replaces “corneal surface disease and dry eyes” with “nonmalignant ocular surface disease and dry eye disease” under conditions of the human eye an optometrist is authorized to diagnosis and treat.
- Adds hypotrichosis and blepharitis to the list of conditions of the human eye an optometrist is allowed to diagnose and treat.
- Authorizes an optometrist to prescribe, including for rational off-label use, certain TPA.
- Removes the requirement for optometrist to consult with an ophthalmologist or appropriate physician and surgeon when using steroids for certain conditions.
- Removes the requirement that an optometrist consults with the physician treating a patient’s diabetes in developing the glaucoma treatment plan, and inform the physician in writing of any changes in the patient’s glaucoma medication.
- Removes requirements for optometrist requiring consultation and/or referral to an ophthalmologist or appropriate physician and surgeon for certain conditions.
- Adds “tramadol” to the list of TPA an optometrist may use and prescribe, including for rational off-label purposes.
- Deletes the requirement that an optometrist must maintain a written record in the patient’s file of information provided to a patient’s ophthalmologist, the ophthalmologist’s response, and any other relevant information in cases for which an optometrist must consult with an ophthalmologist. Deletes the requirement that this information must be provided upon request of the ophthalmologist and with the consent of the patient.
- Authorizes an optometrist to collect blood by skin puncture for testing patients suspected of having diabetes.
- Authorizes an optometrist to do skin testing to diagnose ocular allergies, limited to the superficial layer of the skin.
- Authorizes an optometrist to use or prescribe diagnostic contact lenses.
- Authorizes an optometrist to use a needle to remove foreign bodies from the cornea, eyelid, and conjunctiva, as specified.
- Revises the qualifications to treat glaucoma in patients over 18 years of age for those licensees who substantially completed certification requirements in place between 2001 and 2008, to require submission of proof of satisfactory completion of case management requirements for glaucoma certification, as required by the CBO.
- Authorizes an optometrist, as specified, to use any topical or oral TPA which is not a controlled substance, noninvasive medical device, or technology whose use does not constitute surgery that is not expressly authorized for use or prescription by an optometrist, if it has received a United States Food and Drug Administration approved indication for the diagnosis or treatment of a condition authorized by the Act. An optometrist shall successfully complete any clinical training imposed by a related manufacturer prior to using any of those TPA or noninvasive medical devices or technologies.
- Authorizes an optometrist, as specified, to use any other topical or oral TPA which is not a controlled substance, noninvasive medical device, or technology whose use does not constitute surgery, that is not expressly authorized for use or prescription by an optometrist and does not meet other requirements, as specified, if approved by the CBO through regulation for the rational treatment of a condition authorized by the Act. Any regulation pursuant to this paragraph shall require a licensee to successfully complete an appropriate amount of clinical training to qualify to use each topical or oral TPA or noninvasive medical device or technology approved by the CBO pursuant to this paragraph.
- Prohibits an optometrist from using injections for cosmetics and the performance of blepharoplasty or other cosmetic surgery procedure that reshapes the normal structures of the body in order to improve appearance and self-esteem.
- Authorizes an optometrist certified to use therapeutic agents and authorized to diagnose and treat specified conditions shall be certified for the administration of immunizations after the optometrist meets all of the following requirements:
- Completes an immunization training program endorsed by the federal Centers for Disease Control and Prevention (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.
- Is certified in basic life support.
- Complies with all state and federal recordkeeping and reporting requirements, including providing documentation to the patient’s primary care provided and entering information in the appropriate immunization registry designated by the immunization branch of the State Department of Public Health.
- Applies for an immunization certificate on a board-approved form.
- Defines “immunization” as the administration of immunizations for influenza, herpes zoster virus, and pneumococcus in compliance with individual Advisory Committee on Immunization Practices (ACIP) vaccine recommendations published by the CDC for persons 18 years of age or older.
- Clarifies the meaning of surgery to not include those provisions added by this bill.
- Adds “steroid induced glaucoma” to the definition of “glaucoma,” and requires an optometrist who has treated a patient for steroid induced glaucoma to promptly notify the prescriber of the steroid medication if the prescriber did not refer the patient to the optometrists for treatment.
- Requires an optometrist to 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. Consultations, referrals, and notifications required by this section shall be documented in the patient record.
- Establishes the application fee for a certificate to administer immunizations is to not exceed $50.
- Makes non-substantive, technical, and other clarifying changes.
Background
An optometrist (Doctor of Optometry or O.D.) is an independent primary health care professional for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures, as well as identify related systemic conditions affecting the eye. ODs prescribe medications, low vision rehabilitation, vision therapy, spectacle lenses, contact lenses, and perform certain surgical procedures. Optometrists have a narrower scope of practice than do ophthalmologists, but are held to the identical standard of care for the same treatments they provide.
Optometrists are trained to diagnose mild to severe eye problems such as serious eye infections, inflammations of the eye, trauma, foreign bodies and glaucoma. They also examine the eye for vision prescription and corrective lenses. Optometrists may also pursue any of five additional state certifications to perform certain advanced procedures: use of diagnostic pharmaceutical agents; use of TPA; lacrimal irrigation and dilation for individuals over the age of 12 + TPA (TPL); diagnosis and treatment of open angle glaucoma for adults + TPA (TPG); and a combination of TPA, TPL and TPG.
Ultimately, this bill allows optometrists to utilize the full extent of their training by expanding their scope of practice to include examination, prevention, diagnosis, and treatment of certain conditions and disorders of the visual system and the human eye.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
California Optometric Association
VSP Vision Care
Numerous Individuals
OPPOSITION: (Verified 8/21/17)
A Voice for Choice Advocacy
National Vaccine Information Center
Numerous individuals
ARGUMENTS IN SUPPORT: The California Optometric Association writes “This bill as amended reflects the agreement of stakeholders based on discussions with the California Medical Association and California Academy of Eye Physicians and Surgeons that are still ongoing. After months of productive negotiations, the only outstanding issue is the question of what additional clinical training should be required before optometrists can use lasers and perform “minor procedures” described in last year’s SB 622. All stakeholders have worked hard and negotiated in good faith to craft a bill that will eliminate arbitrary limits on the optometric profession that will help patients get the timely health care access and preventative care they deserve.”
ARGUMENTS IN OPPOSITION: The National Vaccine Information Center writes to “request that all language allowing optometrists to administer vaccines in AB 443 be stricken. Optometrists are not doctors and vaccines have nothing to do with eyes. People can obtain vaccines from their regular medical providers or at most neighborhood pharmacies. There is no need for vaccine administration to be included in this bill. Additionally, vaccines are medical injections that come with the risk of injury and death as evidenced by the language in AB 443 requiring optometrists to be certified in basic life support.”
ASSEMBLY FLOOR: 74-0, 5/30/17
AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bocanegra, Bonta, Brough, Burke, Caballero, Calderon, Cervantes, Chávez, Chiu, Chu, Cooley, Cooper, Cunningham, Dababneh, Daly, Flora, Fong, Frazier, Friedman, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gomez, Gonzalez Fletcher, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon
NO VOTE RECORDED: Chau, Chen, Choi, Dahle, Eggman, Harper
8/22/17 16:01:07
**** END ****
SENATE COMMITTEE ON
BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
Senator Jerry Hill, Chair
2017 - 2018 Regular
Bill No: Hearing Date: July 10, 2017
Author: | |||
Version: | July 5, 2017 | ||
Urgency: | No | Fiscal: | Yes |
Consultant: | Sarah Huchel | ||
Subject:
SUMMARY:
Expand the optometry scope of practice to include further independence, the administration of specified vaccines, and the treatment of additional conditions, as specified.
Existing law:
- Establishes the California Board of Optometry (CBO) to administer and enforce the Optometry Practice Act (Act). (Business and Professions Code (BPC) § 3010.5)
- Defines the practice of optometry as including 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. (BPC § 3041(a))
- Requires an optometrist to refer to an ophthalmologist a case of unilateral nongranulomatous idiopathic iritis recurring within one year of the initial occurrence. Requires an optometrist to 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. Requires an optometrist to 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. (BPC § 3041 (b)(1)(C))
- Authorizes optometrist who is certified to use therapeutic pharmaceutical agents to also diagnose and treat the human eye or eyes, or any of its or their appendages, for Corneal surface disease. (BPC § 3041 (b)(1)(E))
- Authorizes an optometrist certified to use therapeutic pharmaceutical agents to use specified therapeutic pharmaceutical agents. (BPC § 3041 (c))
- Authorizes optometrists who are already authorized to use therapeutic pharmaceuticals agents to prescribe therapeutic contact lenses or devices that incorporate a medication or therapy that the optometrists is certified to prescribe or provide. (BPC § 3041 (e)(12))
- Requires the CBO to certify any optometrist who graduated from an accredited school of optometry before May 1, 2000, to perform lacrimal irrigation and dilation, excluding probing of the nasal lacrimal tract, on patients 12 years of age and older, after submitting proof of satisfactory completion of 10 procedures under the supervision of an ophthalmologist as confirmed by the ophthalmologist.
(BPC § 3041 (d)(15)) - Lists procedures that optometrists, who are certified to use therapeutic pharmaceutical agents, are authorized to perform. (BPC § 3041 (d))
- Declares that optometrists diagnosing or treating eye disease will be held to the same standard of care to which physicians and surgeons and osteopathic physicians and surgeons are held. (BPC § 3041.1)
This bill:
- Adds “the provision of habilitative optometric services” to the definition of the practice of optometry.
- Removes the requirement that an optometrist must refer cases of unilateral nongranulomatous idiopathic iritis recurring within one year of the initial occurrence to an ophthalmologist.
- Removes the requirement that an optometrist must 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.
- Removes the requirement that an optometrist must 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.
- Replaces “corneal surface disease and dry eyes” with “nonmalignant ocular surface disease and dry eye disease” under conditions of the human eye an optometrist is authorized to diagnosis and treat.
- Adds hypotrichosis and blepharitis to the list of conditions of the human eye an optometrist is allowed to diagnose and treat.
- Authorizes an optometrist to prescribe, including for rational off-label use, certain therapeutic pharmaceutical agents.
- Removes the requirement for optometrist to consult with an ophthalmologist or appropriate physician and surgeon when using steroids for certain conditions.
- Removes the requirement that an optometrist consults with the physician treating a patient’s diabetes in developing the glaucoma treatment plan, and inform the physician in writing of any changes in the patient’s glaucoma medication.
- Removes requirements for optometrist requiring consultation and/or referral to an ophthalmologist or appropriate physician and surgeon for certain conditions.
- Adds “tramadol” to the list of therapeutic pharmaceutical agents an optometrist may use and prescribe, including for rational off-label purposes.
- Deletes the requirement that an optometrist must maintain a written record in the patient’s file of information provided to a patient’s ophthalmologist, the ophthalmologist’s response, and any other relevant information in cases for which an optometrist must consult with an ophthalmologist. Deletes the requirement that this information must be provided upon request of the ophthalmologist and with the consent of the patient.
- Authorizes an optometrist to collect blood by skin puncture for testing patients suspected of having diabetes.
- Authorizes an optometrist to do skin testing to diagnose ocular allergies, limited to the superficial layer of the skin.
- Authorizes an optometrist to use or prescribe diagnostic contact lenses.
- Authorizes an optometrist to use a needle to remove foreign bodies from the cornea, eyelid, and conjunctiva, as specified.
- Revises the qualifications to treat glaucoma in patients over 18 years of age for those licensees who substantially completed certification requirements in place between 2001 and 2008, to require submission of proof of satisfactory completion of case management requirements for glaucoma certification, as required by the CBO.
- Authorizes an optometrist, as specified, to use any topical or oral therapeutic pharmaceutical agent which is not a controlled substance, noninvasive medical device, or technology whose use does not constitute surgery that is not expressly authorized for use or prescription by an optometrist, if it has received a United States Food and Drug Administration approved indication for the diagnosis or treatment of a condition authorized by the Act. An optometrist shall successfully complete any clinical training imposed by a related manufacturer prior to using any of those therapeutic pharmaceutical agents or noninvasive medical devices or technologies.
- Authorizes an optometrist, as specified, to use any other topical or oral therapeutic pharmaceutical agent which is not a controlled substance, noninvasive medical device, or technology whose use does not constitute surgery, that is not expressly authorized for use or prescription by an optometrist and does not meet other requirements, as specified, if approved by the CBO through regulation for the rational treatment of a condition authorized by the Act. Any regulation pursuant to this paragraph shall require a licensee to successfully complete an appropriate amount of clinical training to qualify to use each topical or oral therapeutic pharmaceutical agent or noninvasive medical device or technology approved by the CBO pursuant to this paragraph.
- Prohibits an optometrist from using injections for cosmetics and the performance of blepharoplasty or other cosmetic surgery procedure that reshapes the normal structures of the body in order to improve appearance and self-esteem.
- Authorizes an optometrist certified to use therapeutic agents and authorized to diagnose and treat specified conditions shall be certified for the administration of immunizations after the optometrist meets all of the following requirements:
- Completes an immunization training program endorsed by the federal Centers for Disease Control and Prevention (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.
- Is certified in basic life support.
- Complies with all state and federal recordkeeping and reporting requirements, including providing documentation to the patient’s primary care provided and entering information in the appropriate immunization registry designated by the immunization branch of the State Department of Public Health.
- Applies for an immunization certificate on a board-approved form.
- Defines “immunization” as the administration of immunizations for influenza, herpes zoster virus, and pneumococcus in compliance with individual Advisory Committee on Immunization Practices (ACIP) vaccine recommendations published by the CDC for persons 18 years of age or older.
- Clarifies the meaning of surgery to not include those provisions added by this bill.
- Adds “steroid induced glaucoma” to the definition of “glaucoma,” and requires an optometrist who has treated a patient for steroid induced glaucoma to promptly notify the prescriber of the steroid medication if the prescriber did not refer the patient to the optometrists for treatment.
- Requires an optometrist to 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. Consultations, referrals, and notifications required by this section shall be documented in the patient record.
- Establishes the application fee for a certificate to administer immunizations is to not exceed fifty dollars ($50).
- Makes non-substantive, technical, and other clarifying changes.
FISCAL EFFECT:
This bill is keyed fiscal by Legislative Counsel. According to the Assembly Appropriations Committee analysis dated May 24, 2017, the costs associated with this bill to the CBO are expected to be minor and absorbable (State Optometry Fund).
COMMENTS:
- Purpose. This bill is sponsored by the Author. According to the Author, “Optometry represents a robust network of providers that are well-trained, evenly distributed throughout the state, regulated by the DCA through the Board and well positioned to pay particular attention to currently underserved areas. Optometrists are a provider group who have received a doctorate level education and training that has prepared them to be primary eye care providers that can independently diagnose and treat conditions of the eye.
“AB 443 seeks to expand the optometrist’s scope of practice to allow optometrist to examine, prevent, diagnose, and treat certain conditions and disorders of the visual system and the human eye to the full extent of their training. The negotiated language in the bill includes noninvasive, nonsurgical technology to treat conditions authorized by the Optometric Act, streamlines protocols, and allows optometrists to administer certain vaccines.”
- The Practice of Optometry. An optometrist (Doctor of Optometry or O.D.) is an independent primary health care professional for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures, as well as identify related systemic conditions affecting the eye. ODs prescribe medications, low vision rehabilitation, vision therapy, spectacle lenses, contact lenses, and perform certain surgical procedures. Optometrists have a narrower scope of practice than do ophthalmologists, but are held to the identical standard of care for the same treatments they provide.
An O.D. degree requires both an undergraduate education in a college or university and four years of professional education at a college of optometry. Some optometrists also undertake an optional one year non-surgical residency program to enhance their experience in a particular area. Students graduate with 2,500-3,000 patient encounters; these include a mix of post-surgical, medical and routine visits.
In order to be licensed to practice by the California Board of Optometry, an individual must obtain an O.D. degree, pass the three part National Board of Examiners in Optometry examination, and the California Optometric State Law Examination. There are currently 9,100 optometrists in practice in California.
Optometrists are trained to diagnose mild to severe eye problems such as serious eye infections, inflammations of the eye, trauma, foreign bodies and glaucoma. They also examine the eye for vision prescription and corrective lenses. Optometrists may also pursue any of five additional state certifications to perform certain advanced procedures: use of diagnostic pharmaceutical agents (DPA); use of therapeutic pharmaceutical agents (TPA); lacrimal irrigation and dilation for individuals over the age of 12 + TPA (TPL); diagnosis and treatment of open angle glaucoma for adults + TPA (TPG); and a combination of TPA, TPL and TPG.
- Previous Legislation. SB 622 (Hernandez, 2016) would have expanded the scope of practice for optometrists to include the use noninvasive and nonsurgical technologies to treat conditions authorized by the Act, perform laser and minor procedures, and administer certain vaccines. (Status: This bill was held in the Assembly Business and Professions Committee.)
SB 492 (Hernandez, 2014) would have authorized an optometrist to administer influenza and herpes zoster virus (shingles) immunizations to persons 18 years of age and older after completing a training program. (Status: This bill was held on the Assembly floor.)
- Arguments in Support. The California Optometric Association writes, “This bill as amended reflects the agreement of stakeholders based on discussions with the California Medical Association and California Academy of Eye Physicians and Surgeons that are still ongoing. After months of productive negotiations, the only outstanding issue is the question of what additional clinical training should be required before optometrists can use lasers and perform “minor procedures” described in last year’s SB 622. All stakeholders have worked hard and negotiated in good faith to craft a bill that will eliminate arbitrary limits on the optometric profession that will help patients get the timely health care access and preventative care they deserve.”
- Arguments in Opposition. The National Vaccine Information Center writes to “request that all language allowing optometrists to administer vaccines in AB 443 be stricken. Optometrists are not doctors and vaccines have nothing to do with eyes. People can obtain vaccines from their regular medical providers or at most neighborhood pharmacies. There is no need for vaccine administration to be included in this bill. Additionally, vaccines are medical injections that come with the risk of injury and death as evidenced by the language in AB 443 requiring optometrists to be certified in basic life support.”
SUPPORT AND OPPOSITION:
Support:
California Optometric Association
Numerous Individuals
VSP Vision Care
Oppose:
National Vaccine Information Center
Voice for Choice Advocacy
Numerous individuals.
-- END --
ASSEMBLY THIRD READING
ATR Bill Id:AB 443
Author:(Salas)
As Amended Ver:May 2, 2017
Majority vote
Committee | Votes | Ayes | Noes |
Business & Professions | 12-0 | Low, Brough, Arambula, Bloom, Chiu, Eggman, Gipson, Grayson, Holden, Irwin, Mullin, Ting | |
Appropriations | 17-0 | Gonzalez Fletcher, Bigelow, Bloom, Bocanegra, Bonta, Brough, Gloria, Chau, Quirk, Fong, Friedman, Gallagher, Eduardo Garcia, Jones-Sawyer, Muratsuchi, Obernolte, Reyes |
SUMMARY: Makes a number of changes to the Optometry Practice Act including broadening the scope of practice for optometrists by permitting an optometrist to conduct additional procedures on their patients. Specifically, this bill:
- Adds that the practice of optometry includes habilitative optometric services
- Removes the requirement that unilateral nongranulomatous idiopathic iritis recurring within one year of the initial occurrence shall be referred to an ophthalmologist.
- Removes the requirement that 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.
- Removes the requirement that 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.
- Adds treatment of hypotrichosis and blepharitis to the definition of the practice of optometry.
- Authorizes an optometrist certified to use therapeutic pharmaceutical agents to use topical pharmaceutical agents for the examination of the human eye or eyes for any disease or pathological condition, including, but not limited to, topical miotics.
- Removes the requirement that an optometrist shall consult with an ophthalmologist if the patient's condition worsens 21 days after diagnosis.
- Removes the requirement that an optometrist shall consult with an ophthalmologist or physician after for treatment of topical and oral anti-inflammatories with steroids if the patient's condition worsens 72 hours after the diagnosis, or if the patient's condition has not resolved three weeks after diagnosis.
- Removes the requirement that 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.
- Removes the requirement for treatment of unilateral nonrecurrent nongranulomatous idiopathic iritis or episcleritis, that an optometrist shall consult with an ophthalmologist or appropriate physician and surgeon
- Removes the requirement that for 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.
- Removes the requirement that for treatment of 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.
- Removes the requirement that the optometrist shall refer the patient to an ophthalmologist if requested by the patient or if angle closure glaucoma develops.
- Removes the requirement that 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.
- Removes the requirement that 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.
- Removes the requirement that if the patient has been diagnosed with preseptal cellulitis or dacryocystitis and the condition has not improved 48 hours after diagnosis, the optometrist shall refer the patient to an ophthalmologist.
- Removes the requirement that 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.
- Removes the requirement that if the patient has been diagnosed with herpes simplex viral conjunctivitis, herpes simplex viral dermatitis, varicella zoster viral conjunctivitis, or varicella zoster viral dermatitis, and if the patient's condition worsens seven days after diagnosis, 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.
- Removes the requirement that 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.
- Permits an optometrist who is certified to use therapeutic pharmaceutical agents to do the following:
- Collect blood by skin puncture or venipuncture for testing patients suspected of having diabetes.
- Conduct skin testing to diagnose ocular allergies, limited to the superficial layer of the skin.
- Removal of foreign bodies from the cornea, eyelid, and conjunctiva with any appropriate instrument other than a scalpel.
- Removes the requirement for licensees who have substantially completed the certification requirements pursuant to this section in effect between January 1, 2001, and December 31, 2008, to submit proof of completion of those requirements on or before December 31, 2009.
- Specifies that licensees who completed a didactic course of not less than 24 hours in the diagnosis, pharmacological, and other treatment and management of glaucoma must submit proof of satisfactory completion of the case management requirements for certification established by the Board of Optometry.
- Removes the requirement for 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.
- Removes the requirement 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 of Optometry.
- Permits an optometrist to be certified for the administration of immunizations after the optometrist meets all of the following requirements:
- Completes an immunization training program endorsed by the federal Centers for Disease Control and Prevention (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.
- Is certified in basic life support.
- Complies with all state and federal recordkeeping and reporting requirements, including providing documentation to the patient's primary care provided and entering information in the appropriate immunization registry designated by the immunization branch of the State Department of Public Health.
- Defines "immunization" as the administration of immunizations for influenza, herpes zoster virus, and pneumococcus in compliance with individual Advisory Committee on Immunization Practices vaccine recommendations published by the CDC for persons 18 years of age or older.
- Specifies that an optometrist 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.
- Specifies that 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.
- Removes the requirement that after January 1, 1980. Only those optometrists who have successfully completed educational and examination requirements as determined by the Board of Optometry shall be permitted the use of pharmaceutical agents.
- Removes the requirement for an optometrist issued an original optometrist license under this chapter before January 1, 1996, to use or prescribe therapeutic pharmaceutical agents.
- Authorizes the Board of Optometry to 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:
- 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 an accredited ophthalmology residency program in California.
- 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 and systemic disease. The preceptor shall certify completion of the preceptorship using a form approved by the Board of Optometry. Authorization for the ophthalmologist to serve as a preceptor shall be granted by an accredited school of optometry in California. A preceptor shall be a board- certified ophthalmologist in California licensed by and in good standing with the Medical Board of California. 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.
- Successfully completes a minimum of 20 hours of self-directed education.
- 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.
- Specifies that when any or all requirements have been satisfied on or after July 1, 1992, and before January 1, 1996, an optometrist shall not be required to fulfill the requirements to obtain certification to use therapeutic pharmaceutical agents. The didactic examination that the applicant successfully completed shall meet equivalency standards, as determined by the Board of Optometry.
- Exempts any optometrist who graduated from an accredited school of optometry on or after January 1, 1992, and before January 1, 1996, from fulfilling the requirements above.
- Specifies that the Board of Optometry 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:
- Passes the National Board of Examiners in Optometry's national board examination, or its equivalent, as determined by the Board of Optometry.
- 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 and systemic disease.
- Is certified by an accredited school of optometry as competent in the diagnosis, treatment, and management of ocular and systemic disease to the extent authorized by this section.
- Is certified by an accredited school of optometry as having completed at least 10 hours of experience with a board-certified ophthalmologist.
FISCAL EFFECT: According to the May 24, 2017 analysis prepared by the Assembly Appropriations Committee, the costs to the Board of Optometry are expected to be minor and absorbable.
COMMENTS:
Purpose. This bill is sponsored by the author. No author statement was provided.
Background. According to a report prepared by the Center for the Health Professions at the University of California San Francisco, the number of optometrist licenses in California has declined, but the number of licensees with a secondary practice location has increased. According to the Board of Optometry, there are over 7,000 licensed optometrists in California, the largest population of optometrists in the United States. The majority of the licensed optometrists are generally concentrated in coastal counties, the Bay Area and counties in the Sacramento region. Several counties have no licensed optometrists with an address of record in those counties, and a number of other counties have ratios that indicate there is approximately one optometrist for every 10,000 people.
Optometrists' and Ophthalmologists' Education, Training, and Scope. This bill would expand the types of procedures an optometrist is authorized to perform. This would include some tasks that have been traditionally performed by ophthalmologists. As such, the current education, training and scope of each profession is outlined below.
- Optometrists. Optometrists are trained to diagnose mild to severe eye problems such as serious eye infections, inflammations of the eye, trauma, foreign bodies and glaucoma. They also examine the eye for vision prescription and corrective lenses.
After completion of an undergraduate degree, optometrists complete four years of and accredited optometry college after which they are awarded the Doctor of Optometry degree. Some optometrists also undertake an optional one year non-surgical residency program to enhance their experience in a particular area. Students graduate with 2500 to 3000 patient encounters; these include a mix of post-surgical, medical and routine visits.
Optometrists who graduated from an accredited school or college of optometry on or after May 1, 2008 receive certifications to use diagnostic pharmaceutical agents (DPA); to administer therapeutic pharmaceutical agents (TPA); to perform lacrimal irrigation and dilation (TPL); and to diagnose and treat primary open angle glaucoma (TLG). Optometrists who did not receive these certifications upon licensure may apply for these certifications after meeting the necessary requirements. In order to be certified, the optometrist must pass an exam, obtain a license to practice optometry, be certified by and accredited school of optometry that they are competent in the diagnosis, treatment and management of ocular systemic disease, and complete 10 hours of supervised practice with an ophthalmologist.
- Ophthalmologists. The central focus of ophthalmology is surgery and management of complex eye diseases. An ophthalmologist specializes in the refractive, medical and surgical care of the eyes and visual system and in the prevention of disease and injury.
After obtaining an undergraduate degree, ophthalmologists complete four years at an accredited medical school and earn a Medical Degree. This is followed by a one year internship and a three or four year surgical residency. Many ophthalmologists pursue additional fellowship training in specialized areas such as retina, glaucoma, or cornea. Ophthalmologists may become certified by the American Board of Ophthalmology, which requires, serving as the primary surgeon or first assistant to the primary surgeon for a minimum of 364 eye surgeries.
Other States. Since 1997, there have been over 45 attempts in over 20 states by optometry associations to expand the scope of practice for optometrists including legislating surgery privileges. However, with the exception of Oklahoma and West Virginia, most states continue to prohibit optometrists from performing surgery, and their statutes specify that the license to practice optometry does not include the right to practice medicine. States such as Colorado and North Carolina specifically exclude surgery from their definition of the practice of optometry. Other states have statutes that delineate between laser and non-laser surgery. Optometrists are authorized to prescribe oral medications in all 50 states, they may prescribe oral steroids in 34 states, injections in 15 states and use lasers in 1 state.
Analysis Prepared by: Le Ondra Clark Harvey, Ph.D. / B. & P. / (916) 319-3301 FN: 0000506
Date of Hearing: May 24, 2017
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez Fletcher, Chair
ABPCA Bill Id:AB 443
Author:(Salas) – As Amended Ver:May 2, 2017
Policy Committee: | Business and Professions | Vote: | 12 - 0 |
Urgency: No State Mandated Local Program: Yes Reimbursable: No
SUMMARY:
This bill permits minor changes and expansions in an optometrist's scope of practice. Specifically, this bill:
- Adds habilitative services to the definition of the practice of optometry.
- Removes current provisions of law that specify when an optometrist must refer to an opthamologist. Requires optometrists to consult with and, if necessary, refer to a physician or other health care provider when a situation or condition occurs that is beyond the optometrists’s scope of practice.
- Broadens a current-law requirement that states optometrists are held to the same standard of care to which physicians are held in the diagnosis and treatment of certain eye diseases, to all eye disease diagnosis and treatment activities.
- Allows an optometrist to be certified in the administration of specified immunizations (influenza, herpes zoster virus (shingles), and pneumococcus), in compliance with federal expert recommendations. Establishes a $50 fee for the purpose.
- Allows an optometrist certified to use topical pharmaceutical agents (TPAs) to:
- Treat hypotrichosis (inadequate eyelash growth) and blepharitis (eyelid inflammation).
- Use TPAs for the examination of the human eye or eyes for any disease or pathological condition.
- Perform skin testing to diagnose ocular allergies, limited to the superficial layer of the skin, and collect blood by skin puncture for diabetes tests.
- Use of a needle to remove foreign bodies from the eye.
- Removes restrictions on the use of topical and oral anti-inflammatories.
- Modifies the educational and experience requirements for a TPA certificate.
FISCAL EFFECT:
Costs to the Board of Optometry are expected to be minor and absorbable (State Optometry Fund).
COMMENTS:
- Purpose. This bill is intended to make minor changes to the scope of practice for optometrists. It is a product of negotiations within a working group consisting of doctors, optometrists, and ophthalmologists who have clashed on similar issues in the past. This bill is sponsored by the California Optometric Association and has no known opposition.
- Background. This bill is intended to make several changes to the scope of practice for optometrists licensed and regulated by the Board of Optometry. Current law establishes the scope of practice for optometrists. In general, optometrists are trained and authorized to diagnose mild to severe eye problems, to prescribe corrective lenses, and to provide other specified services. An optometrist may apply for certification to provide certain additional services, such as the administration of topical pharmaceutical agents (TPAs).
Many of the changes made by this bill are self-explanatory. As this bill was significantly amended since policy committee analysis, the rationale for some of the changes is listed below.
- Habilitative services: Habilitation focuses on learning new skills, whereas rehabilitation focuses on regaining skills lost. Optometrists can already perform visual rehabilitation. The addition is intended to clarify optometrist's scope includes serving patients who are learning new skills.
- Hypotrichosis: This addition will allow optometrists to use LATISSE® to treat short eyelashes. LATISSE is a glaucoma drug that grows eyelashes as a side effect, that optometrists can currently only use to treat glaucoma.
- Elimination of protocols that specify when an optometrist must refer to another provider: This section is intended to eliminate specific requirements and instead ensure optometrists are held to the same standard of care as physicians in all circumstances, as well as require them to refer in any case that is beyond an optometrist's scope.
- Other authorizations: Authorizations to perform skin puncture tests for diabetes, skin tests for diagnosing ocular allergies, and using a needle to remove foreign bodies from the eye will all allow optometrists to make use of less invasive methods for diagnosis and treatment.
- Vaccination certificate: By allowing optometrists to perform routine and underutilized adult vaccinations, this bill will expand the number and types of providers authorized to perform such vaccinations and may help improve vaccination rates.
- Prior Legislation. SB 622 (Hernández), of the 2015-16 Legislative Session, and SB 492 (Hernández), of the 2013-14 Legislative Session, also expanded the scope of practice of optometrists. These bills both authorized more procedures than this bill. SB 622 was referred to the Business, Professions, and Consumer Protection Committee and was never heard; SB 492 died on the Assembly Floor.
Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081
Date of Hearing: April 25, 2017
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Evan Low, Chair
ABPCA Bill Id:AB 443
Author:(Salas) – As Introduced Ver:February 13, 2017
SUBJECT: Healing arts: optometry: required examination: notice.
SUMMARY: Requires the Board of Optometry (Board), if it exercises its authority to require an applicant to take the regular examination, to notify the applicant of the timeframe to take and pass the examination and to provide the applicant with a minimum 30 days’ notice before an available examination that the applicant is required to take the examination.
EXISTING LAW:
- Establishes the Board under the Department of Consumer Affairs (DCA), to regulate the practice of optometry. (Business and Professions Code (BPC) § 3000 et seq.).
- States that before the Board sets aside the revocation or suspension of any optometrist license, the Board may require the applicant to pass the regular examination given to applicants for an optometrist license.
THIS BILL:
- States that if the Board requires an applicant to pass the regular examination, the Board shall do both of the following:
- Notify the applicant of the timeframe to take and pass the examination.
- Provide the applicant with a minimum 30 days’ notice before an available examination that the applicant is required to take the examination.
FISCAL EFFECT: Unknown. This bill is keyed fiscal by the Legislative Counsel.
COMMENTS:
Purpose. This bill is sponsored by the author. No author statement was provided.
AMENDMENTS:
The bill should be amended to permit an optometrist to engage in additional functions as follows:
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 disease.
(F) Ocular pain, nonsurgical in cause except when comanaged with the treating physician and surgeon, associated with conditions optometrists are authorized to treat, except when comanaged with the treating physician and surgeon.
(G) Hypotrichosis and blepharitis.
(HGH) Pursuant to subdivision (fe), glaucoma in patients over 18 years of age, as described.
(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 (cc), and the procedures described in subdivision (ee).
(c) (c) In diagnosing and treating the conditions listed in subdivision (bb), an optometrist certified to use therapeutic pharmaceutical agents pursuant to Section 3041.3 may use all of the following therapeutic pharmaceutical agents:
(1) Topical pharmaceuticalPharmaceutical agents for the purposeas described in paragraph (5) of the examination of the human eye or eyes for any disease or pathological condition, including, but not limited to,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 (fe).
(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.
(ed) (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) Collection of blood by skin puncture or venipunctureVenipuncture 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 the Clinical Laboratory Improvement Amendments of 1988 (CLIA) (42 U.S.C. Sec. 263a; Public Law 100-578)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) Skin testing to diagnose ocular allergies, Skin tests shall be limited to the superficial layer of the skin.
(12) (11) Punctal occlusion by plugs, excluding laser, diathermy, cryotherapy, or other means constituting surgery as defined in this chapter.
(132) The prescription of therapeutic contact lenses, including lenses or devices that incorporate a medication or therapy the optometrist is certified to prescribe or provide.
(143) Removal of foreign bodies from the cornea, eyelid, and conjunctiva with any appropriate instrument other than a scalpelor needle. Corneal foreign bodies shall be nonperforating, be no deeper than the midstroma, and require no surgical repair upon removal.
(154) 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 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.
(fe) Anf) The board shall grant a certificate to an optometrist certified pursuant to Section 3041.3 shall be certified3 for the treatment of glaucoma, as described in subdivision (jj), 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) (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.
(4) 5)For licensees who graduated from an accredited school of optometry on or before May 1, 2008, and are not described in paragraph (2), (3), or (3), submission of proof of satisfactory completion of the requirements for certification established by the boardpursuant to Section 3041.10.
(af) (1)The board shall grant to an optometrist a certificate for the use of immunizations described in subdivision (b), if the optometrist is certified pursuant to Section 3041.2 and An optometrist certified pursuant to Section 3014.3 shall be certified for the administration of immunizations after the optometrist meets all of the following requirements:
(1i) Completes an immunization training program endorsed by the federal Centers for Disease Control and Prevention (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.
(2ii) Is certified in basic life support.
(3iii) 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.
(b2) For the purposes of this section, “immunization” means the administration of immunizations for influenza, herpes zoster virus, and pneumococcus in compliance with individual Advisory Committee on Immunization Practices (ACIP) vaccine recommendations published by the CDC for persons 18 years of age or older.
(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 (ed). Thise). Nothing in this subdivision sectiondoes notshall 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.
SECTION 2. Section 3041.1 of the Business and Professions Code is amended to read:
3041.1. Optometrists3041.1. 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. 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.
SECTION 3. Section 3041.2 of the Business and Professions Code is amended to read:
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 this chaptersubdivision (a) of Section 3041. Satisfactory completion of the educational and examination requirements shall be a condition for the issuance of an original optometrist license or certifications pursuant to this chapter. 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
SECTION 4. Section 3041.3 of the Business and Professions Code is amended to read:
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) 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 (TPA) certification 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 arecognized residency review committee in n accredited ophthalmology residency program in California.
(2) (1) 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.with either a TPA-certified optometrist in good standing or a physician and surgeon board-certified in ophthalmology in good standing The training received during the preceptorship shall be on the diagnosis, treatment, and management of ocular and systemic disease. The preceptor shall certify completion of the preceptorship.
Authorization for the ophthalmologist to serve asusing a preceptor shall be providedform approved by an accredited school of optometry in California or by a recognized residency review committee in ophthalmology, and the preceptor shall be a board certified ophthalmologist in California licensed asby an ophthalmologist in California, the 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) 2) Successfully completes a minimum of 20100 hours of self-directed and accredited education. in ocular and systemic diseases within two years prior to meeting the requirements of paragraph (1).
(4) 3) 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 c) The board shall grant a 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 agentscertification 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: passes all sections of the National Board of Examiners in Optometry’s national board examination or its equivalent, as determined by the State Board of Optometry.
(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 agentscertification 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 usegranted a therapeutic pharmaceutical agents certification.
(1) In order to obtain a certificate to use therapeutic pharmaceutical agents certification, 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 (eb). In order for the applicant to be eligible for the certificate to use therapeutic pharmaceutical agents certification, 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 (eb) 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 certification, 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 (fc). In order for the applicant to be eligible for the certificate to use therapeutic pharmaceutical agents certification, 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 (fc) 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.
SECTION 5. 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 bloodborne 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 bloodborne pathogens in health care settings. As necessary, the board may consult with the Medical Board of California, the California Board of Podiatric Medicine, the Board of Registered Nursing, and the Board of Vocational Nursing and Psychiatric Technicians of the State of California, 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 and surgeon ifin either of the following circumstances:
(1) Where an examination of the eyes indicates a substantial likelihood of any pathology that requires the attention of that physician and surgeon.
SECTION 6. Section 3152 of the Business and Professions Code is amended to read:
3152. (2) As required by subdivision (c) of Section 3041.
SECTION 6. Section 3152 of the Business and Professions Code is amended to read:
3152. The amounts of fees and penalties prescribed by this chapter shall be established by the board in amounts not greater than those specified in the following schedule:
(a) The fee for applicants applying for a license shall not exceed two hundred seventy-five dollars ($275).
(b) The fee for renewal of an optometric license shall not exceed five hundred dollars ($500).
(c) The annual fee for the renewal of a branch office license shall not exceed seventy-five dollars ($75).
(d) The fee for a branch office license shall not exceed seventy-five dollars ($75).
(e) The penalty for failure to pay the annual fee for renewal of a branch office license shall not exceed twenty-five dollars ($25).
(f) The fee for issuance of a license or upon change of name authorized by law of a person holding a license under this chapter shall not exceed twenty-five dollars ($25).
(g) The delinquency fee for renewal of an optometric license shall not exceed fifty dollars ($50).
(h) The application fee for a certificate to perform lacrimal irrigation and dilation shall not exceed fifty dollars ($50).
(i) The application fee for a certificate to treat glaucoma shall not exceed fifty dollars ($50).
(j) The fee for approval of a continuing education course shall not exceed one hundred dollars ($100).
(k) The fee for issuance of a statement of licensure shall not exceed forty dollars ($40).
(l) The fee for biennial renewal of a statement of licensure shall not exceed forty dollars ($40).
(m) The delinquency fee for renewal of a statement of licensure shall not exceed twenty dollars ($20).
(n) The application fee for a fictitious name permit shall not exceed fifty dollars ($50).
(o) The renewal fee for a fictitious name permit shall not exceed fifty dollars ($50).
(p) The delinquency fee for renewal of a fictitious name permit shall not exceed twenty-five dollars ($25).
(q) The fee for a retired license shall not exceed twenty-five dollars ($25).
(r) The fee for a retired license with volunteer designation shall not exceed fifty dollars ($50).
(s) The biennial renewal fee for a retired license with volunteer designation shall not exceed fifty dollars ($50).
(t) The application fee for a certificate to perform immunizations shall not exceed fifty dollars ($50).
REGISTERED SUPPORT:
None on file.
REGISTERED OPPOSITION:
None on file.
Analysis Prepared by: Le Ondra Clark Harvey, Ph.D. / B. & P. / (916) 319-3301
Discussed in Hearing
1MIN
Assembly Floor
2MIN
Senate Floor
15MIN
Senate Standing Committee on Business, Professions and Economic Development
1MIN
Assembly Floor
2MIN
Assembly Standing Committee on Appropriations
8MIN
Assembly Standing Committee on Business and Professions
Bill Author
Bill Co-Author(s):