Date of Hearing: May 1, 2019

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

ABPCA Bill Id:AB 1467

Author:(Salas and Low) – As Introduced Ver:February 22, 2019

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill allows optometrists to perform services consistent with their current scope under a written “delegation of services” agreement with an ophthalmologist.

FISCAL EFFECT:

Minor and absorbable costs to the Board of Optometry, assuming agreements are not tracked by the board (Optometry Fund).

COMMENTS:

1. Purpose. This bill seeks to provide a vehicle to discuss further changes in the scope of services that can be performed by an optometrist through a delegation agreement with an ophthalmologist.
2. Background. California, unlike other states, does not generally allow optometrists to perform minor surgical procedures independently. This has been a source of frustration for many optometrists who are trained in these procedures in optometry school, but are unable to perform them in California. Legislation enacted in recent years allows optometrists to treat glaucoma, use therapeutic pharmaceutical agents and employ the use of new drugs and technologies to treat certain conditions, consistent with their training and newly developed certifications.

The author’s intention is to expand the authority of an optometrist to perform certain procedures while ensuring physician oversight.

1. Prior Legislation. AB 443 (Salas), Chapter 549, Statutes of 2017, made 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.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: April 23, 2019

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

Evan Low, Chair

ABPCA Bill Id:AB 1467

Author:(Salas) – As Introduced Ver:February 22, 2019

SUBJECT: Optometrists: scope of practice: delegation of services agreement.

SUMMARY: Authorizes an optometrist to provide services set forth in a delegation of services agreement between the optometrist and an ophthalmologist.

EXISTING LAW:

1. Establishes the State Board of Optometry for the licensure and regulation of optometrists, registered dispensing opticians, contact lens dispensers, spectacle lens dispensers, and nonresident contact lens dispensers. (Business and Professions Code (BPC) § 3000 et al.)
2. Establishes the Medical Board of California for the licensure and regulation of physicians and surgeons, including ophthalmologists specializing in the diagnosis and treatment of eye disorders. (BPC §§ 2000 et seq.)
3. Makes it unlawful for a person to engage in or advertise the practice of optometry without having first obtained an optometrist license from the Board. (BPC § 3040)
4. States that protection of the public is the highest priority of the Board in exercising its licensing, regulatory, and disciplinary functions. (BPC Section 3010.1)
5. Provides for the certification of optometrists to use therapeutic pharmaceutical agents and the authorization to diagnose and treat 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. (BPC § 3041.)

THIS BILL:

1. States that it is the intent of the Legislature to authorize ophthalmologists to enter into agreements for the delegation of services by ophthalmologists to optometrists that will increase the two professions’ collaboration in the treatment of patients, and that delegation of service agreements between ophthalmologists and optometrists will improve access to quality vision care as well as provide options for screening and early diagnosis of systemic diseases.
2. Provides that in addition to the practice authority currently granted to an optometrist, an optometrist may provide services set forth in a delegation of services agreement between an optometrist and an ophthalmologist.
3. Defines “delegation of services agreement” as a writing between an ophthalmologist and an optometrist authorizing the optometrist to perform certain services.

FISCAL EFFECT: Unknown; this bill is keyed fiscal by the Legislative Counsel.

COMMENTS:

Purpose. This bill is sponsored by the California Optometric Association. According to the author:

California’s health care workforce shortage is in the headlines – and the impact on Californians’ health is growing worse. According to a new report from the California Future Health Workforce Commission, seven million Californians already live in Health Professional Shortage Areas, facing long waits or long drives for care. The majority are Latino, African American and Native American. As California’s population grows older and the state confronts chronic diseases like diabetes, the state needs to broaden its strategies for meeting the needs of our diverse population. Optometrists are extensively trained and are well-positioned throughout the state to meet the increasing demand for specialized eye care services.

Background. In the wake of what many regard to be a physician shortage in California, efforts have been made to expand the scope of practice for optometrists to provide services traditionally reserved for physicians and surgeons specializing in ophthalmology. For example, legislation enacted in recent years have allowed optometrists to treat glaucoma, use therapeutic pharmaceutical agents, and employ the use of new drugs and technologies to treat certain conditions. These efforts have drawn on the extensive training optometrists receive to empower them to provide additional services and alleviate the need for patients to obtain care from an ophthalmologist.

However, unlike in other states, California does not generally allow optometrists to perform minor surgical procedures independently. This has been a source of frustration for many optometrists who are trained in these procedures in optometry school, but are unable to perform them as long as they practice in California. The intent of this legislation is to provide a path forward for statute to authorize optometrists to take on some procedures currently only available to physicians and surgeons. The bill would authorize an optometrist to provide services that are included in a delegation of services agreement with an ophthalmologist, in which a physician expressly authorizes the optometrist to perform those services. These types of documents are frequently used by physicians who allow another license type to perform services on their behalf under supervision. The author’s intention is to ultimately develop legislation that would expand the authority of an optometrist to perform certain procedures, while ensuring that a licensed physician ultimately remains involved.

Prior Related Legislation. AB 443 (Salas, Chapter 549, Statutes of 2017) made 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.

REGISTERED SUPPORT:

California Optometric Association (Sponsor)

REGISTERED OPPOSITION:

None on file.

Analysis Prepared by: Robert Sumner / B. & P. / (916) 319-3301