Bill Summary – FastDemocracy

CERTIFICATION OF ENROLLMENT
                      SUBSTITUTE SENATE BILL 5389
                       Chapter 400, Laws of 2023
                               68th Legislature
                             2023 Regular Session
                  PRACTICE OF OPTOMETRY—MODIFICATION
                     EFFECTIVE DATE: July 23, 2023
Passed by the Senate April 18, 2023                 CERTIFICATE
  Yeas 47 Nays 1
                                       I, Sarah Bannister, Secretary of
                                       the   Senate   of   the   State  of
              DENNY HECK               Washington, do hereby certify that
President of the Senate                the attached is SUBSTITUTE SENATE
                                       BILL 5389 as passed by the Senate
                                       and the House of Representatives on
                                       the dates hereon set forth.
Passed by the House April 10, 2023
  Yeas 81 Nays 15
                                                 SARAH BANNISTER
            LAURIE JINKINS                                         Secretary
Speaker of the House of
Representatives
Approved May 9, 2023 2:40 PM                           FILED
                                                    May 10, 2023
                                               Secretary of State
              JAY INSLEE                       State of Washington
Governor of the State of Washington
                           SUBSTITUTE SENATE BILL 5389
                             AS AMENDED BY THE HOUSE
                   Passed Legislature - 2023 Regular Session
     State of Washington         68th Legislature        2023 Regular Session
     By Senate Health & Long Term Care (originally sponsored by Senators
     Cleveland, Rivers, Robinson, Van De Wege, Conway, Holy, Schoesler, L.
     Wilson, Lovick, Randall, and C. Wilson)
     READ FIRST TIME 02/17/23.
      AN ACT Relating to the practice of optometry, including expanding
  the optometric scope of practice to include specified procedures not
  including the use of lasers, requiring a licensing endorsement to
  perform these procedures that is based upon mandated educational
  criteria and hands-on training, and amending the board of optometry's
  operating   procedures;  amending  RCW   18.53.010,   18.54.050,  and
  18.54.070; adding a new section to chapter 18.54 RCW; and providing
  an expiration date.
  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
     Sec. 1.    RCW 18.53.010 and 2015 c 113 s 1 are each amended to
 read as follows:
     (1) The practice of optometry is defined as the examination of
 the human eye, the examination and ascertaining any defects of the
 human vision system, and the analysis of the process of vision. The
 practice of optometry may include, but not necessarily be limited to,
 the following:
     (a) The employment of any objective or subjective means or
 method, including the use of drugs, for diagnostic and therapeutic
 purposes by those licensed under this chapter and who meet the
 requirements of subsections (((2))) (4) and (((3))) (6) of this
 section, and the use of any diagnostic instruments or devices for the
                                       p. 1                       SSB 5389.SL
 examination or analysis of the human vision system, the measurement
 of the powers or range of human vision, or the determination of the
 refractive powers of the human eye or its functions in general;
 ((and))
     (b) The prescription and fitting of lenses, prisms, therapeutic
 or refractive contact lenses and the adaption or adjustment of frames
 and lenses used in connection therewith; ((and))
     (c) The prescription and fitting of contact lenses for the
 purpose of altering refractive error or to treat eye disease;
     (d) The prescription and provision of visual therapy, neuro-
 optometry rehabilitation, therapeutic aids, subnormal vision therapy,
 orthoptics, and other optical devices; ((and
     (d))) (e) The ascertainment of the perceptive, neural, muscular,
 or pathological condition of the visual system; ((and
     (e))) (f) The adaptation of prosthetic eyes;
     (g) Ordering necessary diagnostic lab or imaging tests including,
 but not limited to, finger-stick testing and collecting samples for
 culturing;
     (h) Dispensing of medication samples to initiate treatment is
 permitted; and
     (i) Removal of nonpenetrating foreign bodies, debridement of
 tissue, epilation of misaligned eyelashes, placement of punctal or
 lacrimal plugs, including devices containing pharmaceutical agents
 implanted in the lacrimal system, dilation and irrigation of the
 lacrimal system, nonlaser light therapy, and placement of biologic
 membranes.
     (2)(a) The practice of optometry may include the following
 advanced procedures:
     (i) Common complication of the lids, lashes, and lacrimal
 systems;
     (ii) Chalazion management, including injection and excision;
     (iii)    Injections,  including    intramuscular   injections  of
 epinephrine and subconjunctival and subcutaneous injections of
 medications;
     (iv) Management of lid lesions, including intralesional injection
 of medications;
     (v) Preoperative and postoperative care related to these
 procedures;
     (vi) Use of topical and injectable anesthetics; and
                                     p. 2                      SSB 5389.SL
     (vii) Eyelid surgery, excluding any cosmetic surgery or surgery
 requiring the use of general anesthesia.
     (b) An optometrist shall not perform any advanced procedures
 listed in this subsection until he or she receives a license
 endorsement issued by the optometry board. The board may not issue an
 endorsement unless the licensed optometrist meets the educational,
 training, and competence criteria set forth in this section.
     (3) The practice of optometry does not include:
     (a) Performing retinal laser procedures, laser-assisted in situ
 keratomileus,    photorefractive   keratectomy,     laser   epithelial
 keratomileusis, or any forms of refractive surgery, other than light
 adjustable lens procedures;
     (b) Penetrating keratoplasty, corneal transplant, or lamellar
 keratoplasty;
     (c) Administering intravenous or general anesthesia;
     (d) Performing surgery with general anesthesia;
     (e) Providing laser or nonlaser injections into the vitreous
 chamber of the eye to treat any macular or retinal disease;
     (f) Performing surgery related to the removal of the eye from a
 living human being;
     (g) Performing surgery requiring a full thickness incision or
 excision of the cornea or sclera other than paracentesis in an
 emergency situation requiring immediate reduction of the pressure
 inside of the eye;
     (h) Performing surgery requiring incision of the iris and ciliary
 body, including iris diathermy or cryotherapy;
     (i) Performing surgery requiring incision of the vitreous or
 retina;
     (j) Performing surgical extraction of the crystalline lens;
     (k) Performing surgical intraocular implants;
     (l)   Performing  incisional   or   excisional  surgery   of  the
 extraocular muscles;
     (m) Performing surgery of the eyelid for malignancies or for
 incisional cosmetic or mechanical repair of blepharochalasis, ptosis,
 or tarsorrhaphy;
     (n) Performing surgery of the bony orbit, including orbital
 implants;
     (o) Performing incisional or excisional surgery of the lacrimal
 system other than lacrimal probing or related procedures;
                                     p. 3                      SSB 5389.SL
     (p) Performing surgery requiring full thickness conjunctivoplasty
 with graft or flap;
     (q) Performing any surgical procedure that does not provide for
 the correction and relief of ocular abnormalities;
     (r) Suturing;
     (s) Providing an incision into the eyeball;
     (t) Providing sub-tenon, retrobulbar, intraorbital, or botulinum
 toxin injection; or
     (u) Performing pterygium surgery.
     (4)(a) Those persons using topical and oral drugs for diagnostic
 and therapeutic purposes in the practice of optometry shall have a
 minimum of ((sixty)) 60 hours of didactic and clinical instruction in
 general and ocular pharmacology as applied to optometry, as
 established by the optometry board, and certification from an
 institution of higher learning, accredited by those agencies
 recognized by the United States ((office of education or the council
 on postsecondary)) department of education or the council on higher
 education accreditation to qualify for certification by the optometry
 board of Washington to use drugs for diagnostic and therapeutic
 purposes.
     (b) Those persons using or prescribing topical drugs for
 therapeutic purposes in the practice of optometry must be certified
 under (a) of this subsection, and must have an additional minimum of
 ((seventy-five)) 75 hours of didactic and clinical instruction as
 established by the optometry board, and certification from an
 institution of higher learning, accredited by those agencies
 recognized by the United States ((office of education or the council
 on postsecondary)) department of education or the council on higher
 education accreditation to qualify for certification by the optometry
 board of Washington to use drugs for therapeutic purposes.
     (c) Those persons using or prescribing drugs administered orally
 for diagnostic or therapeutic purposes in the practice of optometry
 shall be certified under (b) of this subsection, and shall have an
 additional minimum of ((sixteen)) 16 hours of didactic and eight
 hours of supervised clinical instruction as established by the
 optometry board, and certification from an institution of higher
 learning, accredited by those agencies recognized by the United
 States ((office of education or the council on postsecondary))
 department of education or the council on higher education
 accreditation to qualify for certification by the optometry board of
                                     p. 4                      SSB 5389.SL
 Washington to administer, dispense, or prescribe oral drugs for
 diagnostic or therapeutic purposes.
     (d) Those persons administering epinephrine by injection for
 treatment of anaphylactic shock in the practice of optometry must be
 certified under (b) of this subsection and must have an additional
 minimum   of  four   hours  of   didactic   and  supervised  clinical
 instruction, as established by the optometry board, and certification
 from an institution of higher learning, accredited by those agencies
 recognized by the United States ((office of education or the council
 on postsecondary)) department of education or the council on higher
 education accreditation to qualify for certification by the optometry
 board to administer epinephrine by injection.
     (e) Such course or courses shall be the fiscal responsibility of
 the participating and attending optometrist.
     (f)(((i))) All persons receiving their initial license under this
 chapter on or after January 1, 2007, must be certified under (a),
 (b), (c), and (d) of this subsection.
     (((ii) All persons licensed under this chapter on or after
 January 1, 2009, must be certified under (a) and (b) of this
 subsection.
     (iii) All persons licensed under this chapter on or after January
 1, 2011, must be certified under (a), (b), (c), and (d) of this
 subsection.
     (3))) (5)(a) To receive a license endorsement to perform the
 advanced procedures listed in this section, a licensed optometrist
 must:
     (i) Successfully complete postgraduate courses as designated by
 the optometry board that provide adequate training on those
 procedures. Any course that is offered by an institution of higher
 education accredited by those agencies recognized by the United
 States department of education or the council on higher education
 accreditation and approved by the optometry board to qualify for an
 endorsement to perform advanced procedures must contain supervised
 hands-on experience with live patients, or be supplemented by a
 residency, internship, or other supervised program that offers hands-
 on experience with live patients;
     (ii) Successfully complete a national examination for advanced
 procedures, including the lasers and surgical procedures examination,
 injections skill examination, or other equivalent examination as
 designated by the optometry board; and
                                     p. 5                      SSB 5389.SL
     (iii) Enter into an agreement with a qualified physician licensed
 under chapter 18.71 RCW or an osteopathic physician licensed under
 chapter 18.57 RCW for rapid response if complications occur during an
 advanced procedure.
     (b) Upon completion of the above listed requirements, proof of
 training shall be submitted to the optometry board for approval. No
 optometrist may perform the advanced procedures listed in subsection
 (2) of this section until they have received confirmation of the
 endorsement in writing.
     (6) The optometry board shall establish a list of topical drugs
 for diagnostic and treatment purposes limited to the practice of
 optometry, and no person licensed pursuant to this chapter shall
 prescribe, dispense, purchase, possess, or administer drugs except as
 authorized and to the extent permitted by the optometry board.
     (((4))) (7) The optometry board must establish a list of oral
 Schedule III through V controlled substances and any oral legend
 drugs, with the approval of and after consultation with the pharmacy
 quality assurance commission. The optometry board may include
 Schedule   II    hydrocodone   combination  products   consistent   with
 subsection (((6))) (9) of this section. No person licensed under this
 chapter   may   use,    prescribe,  dispense,   purchase,  possess,   or
 administer these drugs except as authorized and to the extent
 permitted by the optometry board. ((No optometrist may use,
 prescribe,    dispense,    or  administer  oral   corticosteroids))   To
 prescribe oral corticosteroids for more than seven days, an
 optometrist must consult with a licensed physician.
     (a) The optometry board, with the approval of and in consultation
 with the pharmacy quality assurance commission, must establish, by
 rule, specific guidelines for the prescription and administration of
 drugs by optometrists, so that licensed optometrists and persons
 filling their prescriptions have a clear understanding of which drugs
 and which dosages or forms are included in the authority granted by
 this section.
     (b) An optometrist may not((:
     (i) Prescribe)) prescribe, dispense, or administer a controlled
 substance for more than seven days in treating a particular patient
 for a single trauma, episode, or condition or for pain associated
 with or related to the trauma, episode, or condition((; or
                                      p. 6                       SSB 5389.SL
     (ii) Prescribe an oral drug within ninety days following
 ophthalmic surgery unless the optometrist consults with the treating
 ophthalmologist)).
     (c) If treatment exceeding the limitation in (b)(((i))) of this
 subsection is indicated, the patient must be referred to a physician
 licensed under chapter 18.71 RCW.
     (d) The prescription or administration of drugs as authorized in
 this section is specifically limited to those drugs appropriate to
 treatment of diseases or conditions of the human eye and the adnexa
 that are within the scope of practice of optometry. The prescription
 or administration of drugs for any other purpose is not authorized by
 this section.
     (((5))) (8) The optometry board shall develop a means of
 identification and verification of optometrists certified to ((use
 therapeutic drugs for the purpose of issuing prescriptions as
 authorized by this section)) perform advanced procedures.
     (((6))) (9) Nothing in this chapter may be construed to authorize
 the   use,    prescription,   dispensing,   purchase,   possession,   or
 administration of any Schedule I or II controlled substance, except
 Schedule II hydrocodone combination products. The provisions of this
 subsection must be strictly construed.
     (((7) With the exception of the administration of epinephrine by
 injection for the treatment of anaphylactic shock, no injections or
 infusions may be administered by an optometrist.
     (8))) (10) Nothing in this chapter may be construed to authorize
 optometrists to perform ophthalmic surgery. Ophthalmic surgery is
 defined as any invasive procedure in which human tissue is cut,
 ablated, or otherwise penetrated by incision, injection, laser,
 ultrasound, or other means, in order to: Treat human eye diseases;
 alter or correct refractive error; or alter or enhance cosmetic
 appearance. Nothing in this chapter limits an optometrist's ability
 to   use   diagnostic   instruments   utilizing   laser  or   ultrasound
 technology. Ophthalmic surgery, as defined in this subsection, does
 not include the advanced procedures listed in subsection (2)(a) of
 this section, removal of superficial ocular fo