Today's Law As Amended


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AB-443 Optometry: scope of practice.(2017-2018)



As Amends the Law Today
As Amends the Law on Nov 27, 2017


SECTION 1.

 Section 1209 of the Business and Professions Code is amended to read:

1209.
 (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.
(E) A duly licensed dentist serving as the director of a laboratory that performs only clinical laboratory tests authorized within the scope of practice of dentistry as delineated under Section 1625.
(F) A pharmacist-in-charge of a pharmacy serving as the director of a laboratory that only performs tests waived pursuant to the federal Clinical Laboratory Improvement Amendments of 1988 (42 U.S.C. Sec. 263a), as authorized by the Pharmacy Law (Chapter 9 (commencing with Section 4000)).
(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, they  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. They  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 they have  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 individual’s 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 diagnosis, prevention, treatment, and management prevention and diagnosis  of disorders and dysfunctions of the visual system, as authorized by this chapter, as  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 eyes and their adnexa, including through the use of all topical and oral diagnostic pharmaceutical agents that are not controlled substances, and  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, using,  prescribing  or directing the use of  of, or using,  any optical device in connection with ocular exercises, visual training, vision training, or orthoptics.
(4) The prescribing, fitting, or  prescribing of contact and spectacle lenses for, or the fitting or  adaptation of contact and spectacle lenses to, the human eyes, eye,  including lenses that may be classified as drugs or devices by any law of the United States or of this state, and diagnostic or therapeutic contact lenses that incorporate a medication or therapy the optometrist is certified to prescribe or provide. 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.
(5) (b)  For (1)   an optometrist certified  An optometrist who is certified to use therapeutic pharmaceutical agents,  pursuant to Section 3041.3, diagnosing and preventing conditions and diseases of the human eyes and their adnexa, and treating nonmalignant conditions and diseases of the anterior segment of the human eyes and their adnexa, including ametropia and presbyopia: 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).
(A) (c)  Using or prescribing, including for rational off-label purposes, topical and oral prescription and nonprescription therapeutic pharmaceutical agents that are not controlled substances and are not antiglaucoma agents or limited or excluded by subdivision (b). For purposes of this section, “controlled substance” has the same meaning as used 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.). 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 patient’s 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.
(B) (14)  Prescribing the oral analgesic controlled substance codeine  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.),  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).
(C) (d)  If also certified under subdivision (c), using or prescribing topical and oral antiglaucoma agents for the medical treatment of all primary open-angle, exfoliation, pigmentary, and steroid-induced glaucomas in persons 18 years of age or over. In the case of steroid-induced glaucoma, the prescriber of the steroid medication shall be promptly notified if the prescriber did not refer the patient to the optometrist for treatment. 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.
(D) (5)  If also certified under subdivision (d), administration of immunizations for influenza, herpes zoster virus, pneumococcus, and SARS-CoV-2 in compliance with individual Advisory Committee on Immunization Practices (ACIP) vaccine recommendations published by the federal Centers for Disease Control and Prevention (CDC) in persons 18 years of age or over. 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.
(E) (9)  Utilizing the following techniques and instrumentation 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 and or  diseases of the eye and adnexa: or adnexa. An optometrist may order other types of images subject to prior consultation with an ophthalmologist or appropriate physician and surgeon. 
(i) Laboratory tests or examinations ordered from an outside facility.
(ii) (10)  Laboratory tests or examinations performed in an office  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), which shall also be allowed for: 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. 
(I) Detecting indicators of possible systemic disease that manifests in the eye for the purpose of facilitating appropriate referral to or consultation with a physician and surgeon.
(II) Detecting the presence of SARS-CoV-2 virus.
(iii) Skin testing performed in an office to diagnose ocular allergies, limited to the superficial layer of the skin.
(iv) X-rays ordered from an outside facility.
(v) Other imaging studies ordered from an outside facility subject to prior consultation with an appropriate physician and surgeon.
(vi) Other imaging studies performed in an office, including those that utilize laser or ultrasound technology, but excluding those that utilize radiation.
(F) Performing the following procedures, which are excluded from restrictions imposed on the performance of surgery by paragraph (6) of subdivision (b), unless explicitly indicated:
(i) Corneal scraping with cultures.
(ii) Debridement of corneal epithelium not associated with band keratopathy.
(iii) Mechanical epilation.
(iv) Collection of blood by skin puncture or venipuncture for laboratory testing authorized by this subdivision.
(v) (11)  Suture removal subject to comanagement requirements in paragraph (7) of subdivision (b). Punctal occlusion by plugs, excluding laser, diathermy, cryotherapy, or other means constituting surgery as defined in this chapter. 
(vi) Treatment or removal of sebaceous cysts by expression.
(vii) (12)  Lacrimal punctal occlusion using plugs, or placement of a stent or similar device in a lacrimal canaliculus intended to deliver a medication  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.
(viii) (13)  Foreign body and staining removal  Removal of foreign bodies  from the cornea, eyelid, and conjunctiva with any appropriate instrument. Removal of corneal foreign bodies and any related stain shall, as relevant, be limited to that which is nonperforating,  instrument other than a scalpel. Corneal foreign bodies shall be nonperforating, be  no deeper than the midstroma, and not reasonably anticipated to require surgical repair. require no surgical repair upon removal. 
(ix) (14)  Lacrimal irrigation and dilation in patients  For patients over  12 years of age or over,  age, lacrimal irrigation and dilation,  excluding probing of the nasolacrimal  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.
(x) Administration of oral fluorescein for the purpose of ocular angiography.
(xi) (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.
(xii) (16)  Use of noninvasive devices delivering intense pulsed light therapy or low-level light therapy that do not rely on laser technology, limited to treatment of conditions and diseases of the adnexa. Skin testing to diagnose ocular allergies, limited to the superficial layer of the skin. 
(xiii) Use of an intranasal stimulator in conjunction with treatment of dry eye syndrome.
(G) Using additional noninvasive medical devices or technology that:
(i) Have received a United States Food and Drug Administration approved indication for the diagnosis or treatment of a condition or disease authorized by this chapter. A licensee shall successfully complete any clinical training imposed by a related manufacturer prior to using any of those noninvasive medical devices or technologies.
(ii) Have been approved by the board through regulation for the rational treatment of a condition or disease 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 noninvasive medical device or technology approved by the board pursuant to this paragraph.
(b) Exceptions or limitations to the provisions of subdivision (a) are as follows:
(1) Treatment of the following is excluded from the practice of optometry in a patient under 18 years of age, unless explicitly allowed otherwise:
(A) Anterior segment inflammation, which shall not exclude treatment of:
(i) The conjunctiva.
(ii) Nonmalignant ocular surface disease, including dry eye syndrome.
(iii) Contact lens-related inflammation of the cornea.
(iv) An infection of the cornea.
(B) Conditions or diseases of the sclera.
(2) Use of any oral prescription steroid anti-inflammatory medication for a patient under 18 years of age shall be done pursuant to a documented, timely consultation with an appropriate physician and surgeon.
(3) Use of any nonantibiotic oral prescription medication for a patient under five years of age shall be done pursuant to a documented, prior consultation with an appropriate physician and surgeon.
(4) The following classes of agents are excluded from the practice of optometry unless they have an explicit United States Food and Drug Administration-approved indication for treatment of a condition or disease authorized under this section:
(A) Antiamoebics.
(B) Antineoplastics.
(C) Coagulation modulators.
(D) Hormone modulators.
(E) Immunomodulators.
(5) The following are excluded from authorization under subparagraph (G) of paragraph (5) of subdivision (a):
(A) A laboratory test or imaging study.
(B) (17)  Any noninvasive  Use of any noninvasive medical  device or technology that constitutes surgery under paragraph (6). authorized pursuant to subdivision (f). 
(6) Performing surgery is excluded from the practice of optometry. “Surgery” means any act in which human tissue is cut, altered, or otherwise infiltrated by any means. It does not mean an act that solely involves the administration or prescribing of a topical or oral therapeutic pharmaceutical.
(7) (A) Treatment with topical and oral medications authorized in subdivision (a) related to an ocular surgery shall be comanaged with the ophthalmologist that performed the surgery, or another ophthalmologist designated by that surgeon, during the customary preoperative and postoperative period for the procedure. For purposes of this subparagraph, this may involve treatment of ocular inflammation in a patient under 18 years of age.
(B) Where published, the postoperative period shall be the “global” period established by the federal Centers for Medicare and Medicaid Services, or, if not published, a reasonable period not to exceed 90 days.
(C) Such comanaged treatment may include addressing agreed-upon complications of the surgical procedure occurring in any ocular or adnexal structure with topical and oral medications authorized in subdivision (a). For patients under 18 years of age, this subparagraph shall not apply unless the patient’s primary care provider agrees to allowing comanagement of complications.
(c) (e)  An optometrist certified pursuant to Section 3041.3 shall be certified to medically treat authorized glaucomas under this chapter after meeting the following  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 before  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.
(d) (g)  (1)  An optometrist certified pursuant to Section 3041.3 3014.3  shall be certified to administer authorized immunizations, as described in subparagraph (D) of paragraph (5) of subdivision (a),  for the administration of immunizations  after the optometrist meets all of the following requirements:
(1) (A)  Completes an immunization training program endorsed by the federal Centers for Disease Control and Prevention (CDC) or the Accreditation Council for Pharmacy Education  that, at a minimum, includes hands-on injection technique, clinical evaluation of indications and contraindications contradications  of vaccines, and the recognition and treatment of emergency reactions to vaccines, and maintains that training.
(2) (B)  Is certified in basic life support.
(3) (C)  Complies with all state and federal recordkeeping and reporting requirements, including providing documentation to the patient’s primary care provider provided  and entering information in the appropriate immunization registry designated by the immunization branch of the State Department of Public Health.
(4) (D)  Applies for an immunization certificate in accordance with Section 3041.5. 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.
(e) (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 optometrist’s authority to utilize diagnostic laser and ultrasound technology within his or her scope of practice.
(f) (j)  An optometrist licensed under this chapter is subject to the provisions of Section 2290.5 for purposes of practicing telehealth.
(g) (k)  For the  purposes of this chapter, all  “glaucoma” means either  of the following definitions shall apply: following: 
(1) “Adnexa” means the eyelids and muscles within the eyelids, the lacrimal system, and the skin extending from the eyebrows inferiorly, bounded by the medial, lateral, and inferior orbital rims, excluding the intraorbital extraocular muscles and orbital contents. All primary open-angle glaucoma. 
(2) “Anterior segment” means the portion of the eye anterior to the vitreous humor, including its overlying soft tissue coats. Exfoliation and pigmentary glaucoma. 
(3) “Ophthalmologist” (A)   means a physician and surgeon, licensed under Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code, specializing in treating eye disease. Steroid induced glaucoma. 
(4) (B)  “Physician and surgeon” means a physician and surgeon licensed under Chapter 5 (commencing with Section 2000) of Division 2 of the Business and Professions Code. 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. 
(5) (l)  “Prevention” means use or prescription of an agent or noninvasive device or technology for the purpose of inhibiting the development of an authorized condition or disease. For purposes of this chapter, “adnexa” means ocular adnexa. 
(6) (m)  “Treatment” means use of or prescription of an agent or noninvasive device or technology to alter the course of an authorized condition or disease once it is present.  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 optometrists’s 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 California  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 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 California  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 Optometry’s national board examination or its equivalent, as determined by the California  State Board of Optometry.
(d) The board shall grant a therapeutic pharmaceutical agents certification to any applicant who is an optometrist who obtained their  his or her  license outside of California if they meet  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 their  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 the applicant  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 their  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 the applicant  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 California  State Board of Optometry shall decide all issues relating to the equivalency of an optometrist’s 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 board’s 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 person’s 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 Data Bank  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. 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 board’s 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 board’s 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 person’s 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 board’s 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 board’s 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 person’s 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 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 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).
(u) The application fee for a home residence permit is fifty dollars ($50). The board may increase the fee to not more than one hundred dollars ($100).
(v) The renewal fee for a home residence permit is fifty dollars ($50). The board may increase the fee to not more than one hundred dollars ($100).
(w) The delinquency fee for a home residence permit is twenty-five dollars ($25). The board may increase the fee to not more than one hundred dollars ($100).
(x) The endorsement fee is forty dollars ($40). The board may increase the fee, as necessary to cover the reasonable regulatory costs of administration, to not more than sixty dollars ($60).
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 XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.