CA expanded scope bill tabled

Last month, California Senator Ed Hernandez, OD (D-West Covina), pulled SB 492 from legislative consideration. The bill would have designated optometrists as primary-care providers to diagnose and treat patients with chronic diseases, such as diabetes, in anticipation of a provider shortage after millions of uninsured persons gain coverage under the Affordable Care Act (ACA).

“This is a 2-year bill,” says Sen. Hernandez, “and I’ll bring it back next year. We decided to hold it so we wouldn’t have to dilute it. A lot of pushback is coming from organized medicine. It is one of the largest lobbies in the country, and it can outspend any entity. Usually, scope-of-practice bills are 2-year bills due to lobbying and complexity. We have a commitment from chair of the Business and Professions Committee to work with us to come to some kind of agreement with the opposition.”

If an agreement is not reached, a long-term controlled study will be conducted through the Office of Statewide Health Planning and Development (OSHPD). The study would utilize optometrists in primary care to work in coordinated groups and HMOs and enable them to prescribe for primary-care conditions such as diabetes and hypertension. Says Sen. Hernandez: “We’ll see data that shows this is safe, and it will be more difficult to show that the public will be harmed. The study will give us an evidence-based path to pass that portion of the legislation and get into statute.”

He says that optometry’s scope of practice in California has always been behind that of the rest of the U.S. due to lobbying by the California Medical Association and organized ophthalmology. “But we’re catching up,” he says. “I see a role [for optometry] in the medical management of chronic diseases. There’s a large number of patients who see an optometrist before a primary-care physician. There are many instances where there’s not a physician around, and an optometrist can get on the phone [with a primary-care physician] to get a patient started on medication. I see optometry starting to play a different role.”

Sen. Hernandez would like to set up a standard protocol to manage patients in these situations. 

He anticipates a big capacity problem in rural and inner city areas. “We will have 4.5 million Californians who will be eligible for health care. Some counties, such as Los Angeles or Sacramento, will have more new eligibles than some states. These three professions-optometry, pharmacy, and nurse practitioners- can make the biggest impact.”

In addition, Sen. Hernandez hopes to expand optometry’s scope for lid and laser procedures, such as laser, glaucoma, post cataract surgery, and YAG, and administer vaccines, such as the flu shot. “I believe optometrists can make a bigger impact in primary care,” he says.

SB 492 is one of three bills aimed at increasing non-physician healthcare profession privileges. SB 491 addresses nurse practitioners, which the California legislature recently opted not to advance. SB 493 addresses pharmacists, and, at press time, is on the floor of the Assembly. Sen. Hernandez expects SB 493 to pass through to the Senate, then on to the governor’s desk for signature in the coming weeks.ODT