BP BHEAD INT H [atlas:bill]

AN ACT Relating to the scopes of practice for vision care providers; amending RCW 18.53.010, 18.53.140, 69.41.030, 69.50.101, 18.34.020, 18.34.060, 18.34.050, 18.34.080, 18.34.120, 18.34.136, and 18.34.010; adding a new section to chapter 18.53 RCW; adding a new section to chapter 70.41 RCW; adding new sections to chapter 18.34 RCW; recodifying RCW 18.34.010 and 18.34.060; and repealing RCW 18.34.110.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1. RCW 18.53.010 and 1989 c 36 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, and the treatment of the human eye and the human vision system. The practice of optometry ((~~may~~)) includes, but is not ((~~necessarily be~~)) limited to, the following:

(a) The employment of any objective or subjective means or method, including the use of drugs ((~~topically applied to the eye~~)), for diagnostic and therapeutic purposes by those licensed under this chapter and who meet the requirements of subsections (2) and (3) of this section, and the use of any diagnostic instruments or devices for the 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 provision of visual therapy, therapeutic aids, and other optical devices((~~, and the treatment with topically applied drugs by those licensed under this chapter and who meet the requirements of subsections (2) and (3) of this section~~)); and

(d) The ascertainment of the perceptive, neural, muscular, or pathological condition of the visual system; and

(e) The adaptation of prosthetic eyes.

(2)(a) Those persons using drugs for diagnostic purposes in the practice of optometry shall have a minimum of sixty hours of didactic and clinical instruction in general and ocular pharmacology as applied to optometry((~~, and for therapeutic purposes, an additional minimum of seventy-five hours of didactic and clinical instruction~~)) as established by the 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 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 shall be certified under (a) of this subsection, and shall have an additional minimum of seventy-five hours of didactic and clinical instruction as established by the 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 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, by injection, or by any other method of delivery for therapeutic purposes in the practice of optometry shall be certified under (b) of this subsection, and shall have an additional minimum of twenty hours of didactic and clinical instruction as established by the 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 accreditation to qualify for certification by the optometry board of Washington to use drugs administered orally, by injection, or by any other recognized method of delivery for therapeutic purposes.

(d) Such course or courses, and any other courses required by the board for certification to use any other means, method, or procedure, shall be the fiscal responsibility of the participating and attending optometrist.

(3) The board shall establish a schedule of 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 board.

(a) The board shall establish, by rule, specific guidelines for the prescription and administration of drugs by optometric physicians, so that licensed optometric physicians 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) No optometrist shall prescribe, dispense, or administer a controlled substance for more than seven days in treating a particular patient for a single trauma, episode, or condition.

(c) 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 vision system 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.

(4) The board shall develop a means of identification and verification of optometrists certified to use therapeutic drugs for the purpose of issuing prescriptions, and of optometrists certified to use any other objective or subjective means, method, or procedure, as authorized by this section.

Sec. 2. RCW 18.53.140 and 1991 c 3 s 138 are each amended to read as follows:

It shall be unlawful for any person:

(1) To sell or barter, or offer to sell or barter any license issued by the secretary; or

(2) To purchase or procure by barter any license with the intent to use the same as evidence of the holder's qualification to practice optometry; or

(3) To alter with fraudulent intent in any material regard such license; or

(4) To use or attempt to use any such license which has been purchased, fraudulently issued, counterfeited or materially altered as a valid license; or

(5) To practice optometry under a false or assumed name, or as a representative or agent of any person, firm or corporation with which the licensee has no connection: PROVIDED, Nothing in this chapter nor in the optometry law shall make it unlawful for any lawfully licensed optometrist or association of lawfully licensed optometrists to practice optometry under the name of any lawfully licensed optometrist who may transfer by inheritance or otherwise the right to use such name; or

(6) To practice optometry in this state either for him or herself or any other individual, corporation, partnership, group, public or private entity, or any member of the licensed healing arts without having at the time of so doing a valid license issued by the secretary of health; or

(7) To in any manner barter or give away as premiums either on his own account or as agent or representative for any other purpose, firm or corporation, any eyeglasses, spectacles, lenses or frames; or

(8) To use drugs in the practice of optometry, except ((~~those topically applied for diagnostic or therapeutic purposes~~)) as authorized under RCW 18.53.010; or

(9) To use advertising whether printed, radio, display, or of any other nature, which is misleading or inaccurate in any material particular, nor shall any such person in any way misrepresent any goods or services (including but without limitation, its use, trademark, grade, quality, size, origin, substance, character, nature, finish, material, content, or preparation) or credit terms, values, policies, services, or the nature or form of the business conducted; or

(10) To advertise the "free examination of eyes," "free consultation," "consultation without obligation," "free advice," or any words or phrases of similar import which convey the impression to the public that eyes are examined free or of a character tending to deceive or mislead the public, or in the nature of "bait advertising;" or

(11) To use an advertisement of a frame or mounting which is not truthful in describing the frame or mounting and all its component parts. Or advertise a frame or mounting at a price, unless it shall be depicted in the advertisement without lenses inserted, and in addition the advertisement must contain a statement immediately following, or adjacent to the advertised price, that the price is for frame or mounting only, and does not include lenses, eye examination and professional services, which statement shall appear in type as large as that used for the price, or advertise lenses or complete glasses, viz.: frame or mounting with lenses included, at a price either alone or in conjunction with professional services; or

(12) To use advertising, whether printed, radio, display, or of any other nature, which inaccurately lays claim to a policy or continuing practice of generally underselling competitors; or

(13) To use advertising, whether printed, radio, display or of any other nature which refers inaccurately in any material particular to any competitors or their goods, prices, values, credit terms, policies or services; or

(14) To use advertising whether printed, radio, display, or of any other nature, which states any definite amount of money as "down payment" and any definite amount of money as a subsequent payment, be it daily, weekly, monthly, or at the end of any period of time.

Sec. 3. RCW 69.41.030 and 1996 c 178 s 17 are each amended to read as follows:

It shall be unlawful for any person to sell, deliver, or possess any legend drug except upon the order or prescription of a physician under chapter 18.71 RCW, an osteopathic physician and surgeon under chapter 18.57 RCW, an optometrist licensed under chapter 18.53 RCW who is certified by the optometry board under RCW 18.53.010, a dentist under chapter 18.32 RCW, a podiatric physician and surgeon under chapter 18.22 RCW, a veterinarian under chapter 18.92 RCW, a commissioned medical or dental officer in the United States armed forces or public health service in the discharge of his or her official duties, a duly licensed physician or dentist employed by the veterans administration in the discharge of his or her official duties, a registered nurse or advanced registered nurse practitioner under chapter 18.79 RCW when authorized by the nursing care quality assurance commission, an osteopathic physician assistant under chapter 18.57A RCW when authorized by the board of osteopathic medicine and surgery, a physician assistant under chapter 18.71A RCW when authorized by the medical quality assurance commission, a physician licensed to practice medicine and surgery or a physician licensed to practice osteopathic medicine and surgery, a dentist licensed to practice dentistry, a podiatric physician and surgeon licensed to practice podiatric medicine and surgery, or a veterinarian licensed to practice veterinary medicine, in any province of Canada which shares a common border with the state of Washington or in any state of the United States: PROVIDED, HOWEVER, That the above provisions shall not apply to sale, delivery, or possession by drug wholesalers or drug manufacturers, or their agents or employees, or to any practitioner acting within the scope of his or her license, or to a common or contract carrier or warehouseman, or any employee thereof, whose possession of any legend drug is in the usual course of business or employment: PROVIDED FURTHER, That nothing in this chapter or chapter 18.64 RCW shall prevent a family planning clinic that is under contract with the department of social and health services from selling, delivering, possessing, and dispensing commercially prepackaged oral contraceptives prescribed by authorized, licensed health care practitioners.

Sec. 4. RCW 69.50.101 and 1998 c 222 s 3 are each amended to read as follows:

Unless the context clearly requires otherwise, definitions of terms shall be as indicated where used in this chapter:

(a) "Administer" means to apply a controlled substance, whether by injection, inhalation, ingestion, or any other means, directly to the body of a patient or research subject by:

(1) a practitioner authorized to prescribe (or, by the practitioner's authorized agent); or

(2) the patient or research subject at the direction and in the presence of the practitioner.

(b) "Agent" means an authorized person who acts on behalf of or at the direction of a manufacturer, distributor, or dispenser. It does not include a common or contract carrier, public warehouseperson, or employee of the carrier or warehouseperson.

(d) "Controlled substance" means a drug, substance, or immediate precursor included in Schedules I through V as set forth in federal or state laws, or federal or board rules.

(e)(1) "Controlled substance analog" means a substance the chemical structure of which is substantially similar to the chemical structure of a controlled substance in Schedule I or II and:

(i) that has a stimulant, depressant, or hallucinogenic effect on the central nervous system substantially similar to the stimulant, depressant, or hallucinogenic effect on the central nervous system of a controlled substance included in Schedule I or II; or

(ii) with respect to a particular individual, that the individual represents or intends to have a stimulant, depressant, or hallucinogenic effect on the central nervous system substantially similar to the stimulant, depressant, or hallucinogenic effect on the central nervous system of a controlled substance included in Schedule I or II.

(2) The term does not include:

(i) a controlled substance;

(ii) a substance for which there is an approved new drug application;

(iii) a substance with respect to which an exemption is in effect for investigational use by a particular person under Section 505 of the federal Food, Drug and Cosmetic Act, 21 U.S.C. Sec. 355, to the extent conduct with respect to the substance is pursuant to the exemption; or

(iv) any substance to the extent not intended for human consumption before an exemption takes effect with respect to the substance.

(f) "Deliver" or "delivery," means the actual or constructive transfer from one person to another of a substance, whether or not there is an agency relationship.

(g) "Department" means the department of health.

(h) "Dispense" means the interpretation of a prescription or order for a controlled substance and, pursuant to that prescription or order, the proper selection, measuring, compounding, labeling, or packaging necessary to prepare that prescription or order for delivery.

(i) "Dispenser" means a practitioner who dispenses.

(j) "Distribute" means to deliver other than by administering or dispensing a controlled substance.

(k) "Distributor" means a person who distributes.

(l) "Drug" means (1) a controlled substance recognized as a drug in the official United States pharmacopoeia/national formulary or the official homeopathic pharmacopoeia of the United States, or any supplement to them; (2) controlled substances intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in individuals or animals; (3) controlled substances (other than food) intended to affect the structure or any function of the body of individuals or animals; and (4) controlled substances intended for use as a component of any article specified in (1), (2), or (3) of this subsection. The term does not include devices or their components, parts, or accessories.

(m) "Drug enforcement administration" means the drug enforcement administration in the United States Department of Justice, or its successor agency.

(n) "Immediate precursor" means a substance:

(1) that the state board of pharmacy has found to be and by rule designates as being the principal compound commonly used, or produced primarily for use, in the manufacture of a controlled substance;

(2) that is an immediate chemical intermediary used or likely to be used in the manufacture of a controlled substance; and

(3) the control of which is necessary to prevent, curtail, or limit the manufacture of the controlled substance.

(o) "Isomer" means an optical isomer, but in RCW 69.50.101(r)(5), 69.50.204(a) (12) and (34), and 69.50.206(a)(4), the term includes any geometrical isomer; in RCW 69.50.204(a) (8) and (42), and 69.50.210(c) the term includes any positional isomer; and in RCW 69.50.204(a)(35), 69.50.204(c), and 69.50.208(a) the term includes any positional or geometric isomer.

(p) "Manufacture" means the production, preparation, propagation, compounding, conversion, or processing of a controlled substance, either directly or indirectly or by extraction from substances of natural origin, or independently by means of chemical synthesis, or by a combination of extraction and chemical synthesis, and includes any packaging or repackaging of the substance or labeling or relabeling of its container. The term does not include the preparation, compounding, packaging, repackaging, labeling, or relabeling of a controlled substance:

(1) by a practitioner as an incident to the practitioner's administering or dispensing of a controlled substance in the course of the practitioner's professional practice; or

(2) by a practitioner, or by the practitioner's authorized agent under the practitioner's supervision, for the purpose of, or as an incident to, research, teaching, or chemical analysis and not for sale.

(q) "Marijuana" or "marihuana" means all parts of the plant Cannabis, whether growing or not; the seeds thereof; the resin extracted from any part of the plant; and every compound, manufacture, salt, derivative, mixture, or preparation of the plant, its seeds or resin. The term does not include the mature stalks of the plant, fiber produced from the stalks, oil or cake made from the seeds of the plant, any other compound, manufacture, salt, derivative, mixture, or preparation of the mature stalks (except the resin extracted therefrom), fiber, oil, or cake, or the sterilized seed of the plant which is incapable of germination.

(r) "Narcotic drug" means any of the following, whether produced directly or indirectly by extraction from substances of vegetable origin, or independently by means of chemical synthesis, or by a combination of extraction and chemical synthesis:

(1) Opium, opium derivative, and any derivative of opium or opium derivative, including their salts, isomers, and salts of isomers, whenever the existence of the salts, isomers, and salts of isomers is possible within the specific chemical designation. The term does not include the isoquinoline alkaloids of opium.

(2) Synthetic opiate and any derivative of synthetic opiate, including their isomers, esters, ethers, salts, and salts of isomers, esters, and ethers, whenever the existence of the isomers, esters, ethers, and salts is possible within the specific chemical designation.

(3) Poppy straw and concentrate of poppy straw.

(4) Coca leaves, except coca leaves and extracts of coca leaves from which cocaine, ecgonine, and derivatives or ecgonine or their salts have been removed.

(5) Cocaine, or any salt, isomer, or salt of isomer thereof.

(6) Cocaine base.

(7) Ecgonine, or any derivative, salt, isomer, or salt of isomer thereof.

(8) Any compound, mixture, or preparation containing any quantity of any substance referred to in subparagraphs (1) through (7).

(s) "Opiate" means any substance having an addiction-forming or addiction-sustaining liability similar to morphine or being capable of conversion into a drug having addiction-forming or addiction-sustaining liability. The term includes opium, substances derived from opium (opium derivatives), and synthetic opiates. The term does not include, unless specifically designated as controlled under RCW 69.50.201, the dextrorotatory isomer of 3-methoxy-n-methylmorphinan and its salts (dextromethorphan). The term includes the racemic and levorotatory forms of dextromethorphan.

(t) "Opium poppy" means the plant of the species Papaver somniferum L., except its seeds.

(u) "Person" means individual, corporation, business trust, estate, trust, partnership, association, joint venture, government, governmental subdivision or agency, or any other legal or commercial entity.

(v) "Poppy straw" means all parts, except the seeds, of the opium poppy, after mowing.

(w) "Practitioner" means:

(1) A physician under chapter 18.71 RCW, a physician assistant under chapter 18.71A RCW, an osteopathic physician and surgeon under chapter 18.57 RCW, an optometrist licensed under chapter 18.53 RCW who is certified by the optometry board under RCW 18.53.010 subject to any limitations in RCW 18.53.010, a dentist under chapter 18.32 RCW, a podiatric physician and surgeon under chapter 18.22 RCW, a veterinarian under chapter 18.92 RCW, a registered nurse, advanced registered nurse practitioner, or licensed practical nurse under chapter 18.79 RCW, a pharmacist under chapter 18.64 RCW or a scientific investigator under this chapter, licensed, registered or otherwise permitted insofar as is consistent with those licensing laws to distribute, dispense, conduct research with respect to or administer a controlled substance in the course of their professional practice or research in this state.

(2) A pharmacy, hospital or other institution licensed, registered, or otherwise permitted to distribute, dispense, conduct research with respect to or to administer a controlled substance in the course of professional practice or research in this state.

(3) A physician licensed to practice medicine and surgery, a physician licensed to practice osteopathic medicine and surgery, a dentist licensed to practice dentistry, a podiatric physician and surgeon licensed to practice podiatric medicine and surgery, or a veterinarian licensed to practice veterinary medicine in any state of the United States.

(x) "Prescription" means an order for controlled substances issued by a practitioner duly authorized by law or rule in the state of Washington to prescribe controlled substances within the scope of his or her professional practice for a legitimate medical purpose.

(y) "Production" includes the manufacturing, planting, cultivating, growing, or harvesting of a controlled substance.

(z) "Secretary" means the secretary of health or the secretary's designee.

(aa) "State," unless the context otherwise requires, means a state of the United States, the District of Columbia, the Commonwealth of Puerto Rico, or a territory or insular possession subject to the jurisdiction of the United States.

(bb) "Ultimate user" means an individual who lawfully possesses a controlled substance for the individual's own use or for the use of a member of the individual's household or for administering to an animal owned by the individual or by a member of the individual's household.

(cc) "Electronic communication of prescription information" means the communication of prescription information by computer, or the transmission of an exact visual image of a prescription by facsimile, or other electronic means for original prescription information or prescription refill information for a Schedule III-V controlled substance between an authorized practitioner and a pharmacy or the transfer of prescription information for a controlled substance from one pharmacy to another pharmacy.

NEW SECTION. Sec. 5. A new section is added to chapter 18.53 RCW to read as follows:

Notwithstanding any other provision of law, no hospital that provides health care services to the general public may discriminate against a qualified optometrist licensed under this chapter who applies for hospital privileges. For purposes of this section, discrimination includes, but is not limited to, the denial of hospital privileges to licensed optometrists who seek such privileges to facilitate the performance of any means, method, or procedure within their scope of practice and who otherwise meet all credentialing requirements reasonably related to the practice of optometry in a hospital setting.

NEW SECTION. Sec. 6. A new section is added to chapter 70.41 RCW to read as follows:

A hospital that provides health care services to the general public may not discriminate against a qualified optometrist licensed under chapter 18.53 RCW who has applied to practice with the hospital solely because the optometrist is board certified or eligible under an approved optometrist certifying board instead of board certified or eligible, respectively, under an approved medical certifying board. For purposes of this section, discrimination includes, but is not limited to, the denial of hospital privileges to licensed optometrists who seek such privileges to facilitate the performance of any means, method, or procedure within their scope of practice and who otherwise meet all credentialing requirements reasonably related to the practice of optometry in a hospital setting.

Sec. 7. RCW 18.34.020 and 1995 c 178 s 1 are each amended to read as follows:

The term "secretary" wherever used in this chapter ((~~shall~~)) means the secretary of health of the state of Washington. The term "apprentice" wherever used in this chapter ((~~shall~~)) means a person who ((~~shall be~~)) is designated an apprentice in the records of the secretary at the request of a physician, registered optometrist, or licensee hereunder, who shall thereafter be the primary supervisor of the apprentice. The apprentice may thereafter receive from a physician, registered optometrist, or licensee hereunder training and direct supervision in the work of a dispensing optician. The term "refracting" whenever used in this chapter means the measurement of the powers or range of a person's vision by the use of a series of lenses and their rotation to determine the degree of correction needed to compensate for hyperopia, myopia, presbyopia, astigmatism, prism, or any combination of these. "Prescription modification" whenever used in this chapter, means the ability of a licensed refracting optician to alter a prescription within a cumulative plus or minus 2.00 diopter of change provided that there is no more than plus or minus 1.00 diopter of change at any one time during a six-month period. A licensed refracting optician must provide a patient with a copy of the changes to take with him or her to a provider of choice. The original prescriber will be notified in writing within fourteen days of any modifications made to the original prescription and will also be provided with a copy of the patient's questionnaire and the signed informed consent document.

Sec. 8. RCW 18.34.060 and 1957 c 43 s 6 are each amended to read as follows:

A dispensing optician is a person who prepares duplications of, or prepares and dispenses lenses, spectacles, eyeglasses and/or appurtenances thereto to the intended wearers thereof on written prescriptions from physicians or optometrists, and in accordance with ((~~such~~)) the prescriptions, measures, adapts, adjusts and fabricates ((~~such~~)) the lenses, spectacles, eyeglasses and/or appurtenances thereto to the human face for the aid or correction of visual or ocular anomalies of the human eye((~~: PROVIDED, HOWEVER, That~~)). However, contact lenses may be fitted only upon a written prescription of a physician or optometrist. A refracting optician is a licensed dispensing optician who has received an endorsement from the secretary to practice refractometry and to modify prescriptions.

Sec. 9. RCW 18.34.050 and 1984 c 287 s 32 are each amended to read as follows:

The dispensing optician examining committee shall meet at such times as deemed necessary by the secretary to prepare and administer the state's licensing examinations and to provide technical expertise, advice, and make recommendations to the secretary on the administration of the dispensing optician statute and disciplinary matters of licensees. The examining committee ((~~shall~~)) consists of ((~~three~~)) five persons. Four persons must be primarily engaged in the business of dispensing opticians and ((~~who currently~~)) hold a ((~~valid~~)) current license under this chapter. One of the licensed dispensing optician members shall be a licensed refracting optician. One member must be a member of the general public. Members of the committee shall be compensated in accordance with RCW 43.03.240 and shall be reimbursed for travel expenses in accordance with RCW 43.03.050 and 43.03.060.

NEW SECTION. Sec. 10. A new section is added to chapter 18.34 RCW to read as follows:

An applicant for endorsement as a refracting optician must first be licensed as a dispensing optician under this chapter and meet the following additional requirements:

(1) Completion of eighty hours of coursework from an accredited or approved institution or association including, but not limited to, the following topics: Theory of refraction, anatomy, pathology, and knowledge of equipment operation;

(2) Completion of two hundred refractive examinations. The two hundred refractive examinations are under the direct supervision of a licensed optometrist or a licensed ophthalmologist who shall certify the completion of the examinations and send notification directly to the department;

(3) Continuing education or competency requirements as determined by the secretary.

The secretary shall adopt by rule the examination requirements to endorse refracting opticians. An applicant for endorsement as a refracting optician may take the examination if he or she pays an examination fee, determined by the secretary, as provided in RCW 43.70.250.

A refracting optician who has successfully completed the requirements of this section will have the endorsement of "CRO" placed on his or her dispensing optician license by the secretary.

Sec. 11. RCW 18.34.080 and 1995 c 198 s 3 are each amended to read as follows:

(1) The examination to license a dispensing optician shall determine whether the applicant has a thorough knowledge of the principles governing the practice of a dispensing optician which is hereby declared necessary for the protection of the public health. The examining committee may ((~~approve an examination prepared or administered by a private testing agency or association of licensing authorities~~)) prepare and administer, or approve the preparation and administration of, examinations for applicants for licensure. The secretary shall license successful examinees and the license shall be conspicuously displayed in the place of business of the licensee.

(2) The written and practical examination to certify a refracting optician shall determine whether the applicant has a thorough knowledge of the principles governing the practice of refraction. After the initial exam, the examining committee may prepare and administer, or approve the preparation and administration of, examinations for applicants for licensure. The secretary shall issue an endorsement to successful examinees and the endorsement shall be conspicuously displayed in the place of business of the licensee.

Sec. 12. RCW 18.34.120 and 1996 c 191 s 18 are each amended to read as follows:

Each licensee ((~~hereunder~~)) or holder of an endorsement under this chapter shall pay a renewal registration fee determined by the secretary as provided in RCW 43.70.250 and 43.70.280. The secretary may adopt rules establishing mandatory continuing education requirements to be met by persons applying for license or endorsement renewal.

Sec. 13. RCW 18.34.136 and 1987 c 150 s 19 are each amended to read as follows:

The uniform disciplinary act, chapter 18.130 RCW, governs unlicensed practice, the issuance and denial of licenses, and the discipline of licensees under this chapter. No person may practice or represent himself or herself as a refracting optician without first having obtained an endorsement from the secretary.

Sec. 14. RCW 18.34.010 and 1957 c 43 s 1 are each amended to read as follows:

Nothing in this chapter shall:

(1) Be construed to limit or restrict a duly licensed physician or optometrist or employees working under the personal supervision of a duly licensed physician or optometrist from the practices enumerated in this chapter, and each such licensed physician and optometrist shall have all the rights and privileges which may accrue under this chapter to dispensing opticians licensed hereunder;

(2) Be construed to prohibit an unlicensed person from performing mechanical work upon inert matter in an optical office, laboratory, or shop;

(3) Be construed to prohibit an unlicensed person from engaging in the sale of spectacles, eyeglasses, magnifying glasses, goggles, sunglasses, telescopes, binoculars, or any such articles which are completely preassembled and sold only as merchandise;

(4) Be construed to authorize or permit a licensee ((~~hereunder~~)) under this chapter to hold himself or herself out as being able to, or to offer to, or to undertake to attempt, by any manner of means, to ((~~examine or~~)) exercise eyes, diagnose, treat, ((~~correct,~~)) relieve, operate, or prescribe for any human ailment, ((~~deficiency,~~)) deformity, disease, or injury.

If a licensed refracting optician is unable to select lenses that provide at a minimum 20/40 vision in either eye to the consumer, he or she shall refer the consumer to a licensed optometrist or ophthalmologist. If a licensed refracting optician is observing change of more than plus or minus 1.00 diopter of power in either eye, he or she shall refer the consumer to a licensed optometrist or ophthalmologist. A licensed refracting optician shall not modify an original prescription beyond plus or minus 2 diopters of change provided that there is no more than plus or minus 1.00 diopter of change at any one time during a six-month period. A licensed refracting optician may only modify a prescription for a consumer that has had an eye health exam within two years for contact lenses and within two years for glasses. A licensed refracting optician will not modify a prescription of a child ten years old or younger or an adult sixty-four years or older. A licensed refracting optician will notify in writing the original prescriber within fourteen days of any modifications made to the original prescription, and will also provide a copy of the patient's questionnaire and the signed informed consent document.

NEW SECTION. Sec. 15. RCW 18.34.110 (Existing practitioner--Fee) and 1991 c 3 s 78 & 1957 c 43 s 11 are each repealed.

NEW SECTION. Sec. 16. RCW 18.34.010, to be codified between RCW 18.34.141 and 18.34.900, and RCW 18.34.060, to be codified between RCW 18.34.020 and 18.34.030, are each recodified.

NEW SECTION. Sec. 17. If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.