S-3765.1  _______________________________________________

                         SENATE BILL 6414

          _______________________________________________

State of Washington      56th Legislature     2000 Regular Session

By Senators Wojahn, Deccio, Rasmussen, Stevens and Winsley

Read first time 01/14/2000.  Referred to Committee on Health & Long‑Term Care.

Requiring the licensure of optometric physician assistants.

    AN ACT Relating to optometric physician assistants; amending RCW 18.71A.060; and adding a new chapter to Title 18 RCW.

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

NEW SECTION. Sec. 1.  The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.

    (1) "Commission" means the Washington state medical quality assurance commission.

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

    (3) "Optometric physician assistant" means a person who is licensed by the commission to practice medicine to a limited extent, but only under the supervision of a physician licensed under chapter 18.71 RCW, and if the optometric physician assistant is academically and clinically prepared, to provide eye care related health care services and perform diagnostic, therapeutic, preventive, and health maintenance services in the specialty of ophthalmology.

    (4) "Physician" includes a physician licensed under chapter 18.71 RCW or an osteopathic physician and surgeon licensed under chapter 18.57 RCW.

    (5) "Practice medicine" has the same meaning as defined in RCW 18.71.011 but shall not extend beyond those ophthalmologic health care services specifically authorized and not prohibited by section 9 of this act.

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

NEW SECTION. Sec. 2.  (1) The commission shall adopt rules that establish the qualifications, educational requirements, and training requirements for licensure as an optometric physician assistant.  The qualifications and requirements include completion of an optometric physician assistant training program approved by the commission, and eligibility to take an examination approved by the commission, but only if the examination tests subjects substantially equivalent to the curriculum of an accredited optometric physician assistant training program.

    (2) The commission shall adopt rules establishing curriculum requirements for optometric physician assistant training programs.  At a minimum, the rules must require that:

    (a) The program be under the control and supervision of physicians specializing in ophthalmology; and

    (b) The program includes substantial and meaningful elements of:

    (i) Appropriately supervised delivery of clinical services of the type for which the student is being trained to deliver;

    (ii) Didactic classes offered by physician faculty members;

    (iii) Presentations of seminar topics to and by the student;

    (iv) Involvement with quality assurance audits; and

    (v) Preparation of case studies as well as periodic formal and objective testing to determine that there is adequate progress by the student through the training program and regimens.

NEW SECTION. Sec. 3.  (1) The commission shall adopt rules governing the extent to which:

    (a) Optometric physician assistant students may practice medicine during training; and

    (b) Optometric physician assistants may practice medicine after successful completion of an optometric physician assistant training course.

    (2) The rules adopted under subsection (1) of this section shall provide that:

    (a) The practice of an optometric physician assistant be limited to the performance of those services permitted by section 9(1) of this act for which he or she is trained, but shall not include services prohibited by section 9(2) of this act; and

    (b) Each optometric physician assistant shall practice medicine only under the supervision and control of a physician licensed in this state, but that supervision and control shall not be construed to require the personal presence of the supervising physician at the place where services are rendered.

NEW SECTION. Sec. 4.  (1) An applicant for licensure as an optometric physician assistant shall file an application with the commission on a form prepared by the secretary and approved by the commission.  The application form must detail the applicant's education, training, and experience and other information as the commission may require.

    (2) Each applicant shall furnish to the commission proof, in a manner deemed satisfactory to the commission, of the following:

    (a) That the applicant has completed an optometric physician assistant program approved by the commission and is eligible to take the examination approved by the commission; and

    (b) That the applicant has a current and unrestricted license as an optometrist under chapter 18.53 RCW and has the training to qualify for certification under RCW 18.53.010 to use drugs for diagnostic and therapeutic purposes, although this does not require that the applicant be certified by the optometry board.

    (3) The commission may approve, deny, or take other disciplinary action upon the application for license as provided in the Uniform Disciplinary Act, chapter 18.130 RCW.  The license shall be renewed as determined under RCW 43.70.250 and 43.70.280.  The commission may authorize the use of alternative supervisors who are licensed either under chapter 18.57 or 18.71 RCW.

    (4) The commission may adopt rules governing mandatory continued education requirements for optometric physician assistants.  The rules shall provide that mandatory continuing education requirements may be met, in part, by showing evidence of completion of approved activities relating to professional liability risk management.

NEW SECTION. Sec. 5.  The Uniform Disciplinary Act, chapter 18.130 RCW, governs the issuance and denial of licenses and the discipline of licensees under this chapter.

NEW SECTION. Sec. 6.  Prior to practicing in this state, an optometric physician assistant must obtain a practice arrangement plan that has been approved by the commission.

NEW SECTION. Sec. 7.  (1) No optometric physician assistant licensed in this state may be employed or supervised by a physician or physician group without the approval of the commission.

    (2) Prior to commencing practice, an optometric physician assistant licensed in this state shall apply to the commission for permission to be employed or supervised by a physician or physician group.  The physician or physician group and optometric physician assistant shall jointly submit a practice arrangement plan to the commission.  The practice arrangement plan shall describe the manner and extent to which the optometric physician assistant will practice and be supervised.  No practice arrangement may be approved where a physician supervises more than three optometric physician assistants, or where a group practice supervises more than three optometric physician assistants per physician.  Whenever an optometric physician assistant is practicing in a manner inconsistent with the approved practice arrangement plan, the commission may take disciplinary action under the Uniform Disciplinary Act, chapter 18.130 RCW.

NEW SECTION. Sec. 8.  No physician who supervises a licensed optometric physician assistant in accordance with and within the terms of any permission granted by the commission is considered as aiding and abetting an unlicensed person to practice medicine.  The supervising physician and optometric physician assistant retain professional and personal responsibility for any act that constitutes the practice of medicine as defined in RCW 18.71.011 when performed by the optometric physician assistant.

NEW SECTION. Sec. 9.  (1) Subject to subsection (2) of this section, health care services performed under this chapter include only the following procedures:

    (a) Prescribing, ordering, or administering any over-the-counter substances;

    (b) Prescribing, ordering, or administering oral legend medications for eye care and controlled substances as defined in Schedules III through V of the Uniform Controlled Substances Act, chapter 69.50 RCW, that are necessary to perform services with the commission-approved practice arrangement of the optometric physician assistant;

    (c) Administering topical anesthesia for procedures of a superficial nature;

    (d) Performing only the following surgical procedures:

    (i) Epilation of the lashes;

    (ii) Removal of foreign bodies that do not penetrate the corneal stroma, and

    (iii) lacrimal irrigation or punctal plug insertion;

    (e) Ordering and interpreting the results of, but not performing, the following diagnostic tests when conducted to ascertain the condition of the eye:

    (i) Cultures of surface materials that involve only swabbing the surface;

    (ii) Blood or serum tests;

    (iii) Urinalysis;

    (iv) Fluorescein angiograms;

    (v) Ultrasound, except on the eye and eye orbit;

    (vi) Radiographs; and

    (vii) CT scans or MRI tests; and

    (f) Ophthalmologic surgical assisting following an approved residency program under the direct supervision of an ophthalmologist.

    (2) Subject to those services expressly referred to in subsection (1) of this section, no health care services may be performed under this chapter in any of the following areas:

    (a) Surgery of any kind, whether performed with knives, machines, light or laser, or with other apparatus, including treating the complications or sequelae of any surgery;

    (b) Prescribing, ordering, or administering legend or controlled substances, including but not limited to:

    (i) Intravenous medications;

    (ii) Subconjunctival steroid injections;

    (iii) Controlled substances as defined in Schedule II of the Uniform Controlled Substances Act, chapter 69.50 RCW;

    (iv) Corticosteroids;

    (v) Antimetabolites;

    (vi) Immunosuppressives; and

    (vii) Enteral or parenteral medications;

    (c) Administering local or systemic anesthesia; or

    (d) Administering or interpreting diagnostic laboratory or imaging tests.

    Failure to prohibit a procedure under this subsection shall not be construed as authority for performing.  The scope of practice of optometric physician assistants is confined to those health services expressly referred to in subsection (1) of this section.

    Sec. 10.  RCW 18.71A.060 and 1994 sp.s. c 9 s 324 are each amended to read as follows:

    No health care services may be performed under this chapter in any of the following areas:

    (1) ((The measurement of the powers or range of human vision, or the determination of the accommodation and refractive state of the human eye or the scope of its functions in general, or the fitting or adaptation of lenses or frames for the aid thereof.

    (2) The prescribing or directing the use of, or using, any optical device in connection with ocular exercises, visual training, vision training, or orthoptics.

    (3))) The prescribing of contact lenses for, or the fitting or adaptation of contact lenses to, the human eye.

    (((4))) (2) Nothing in this section shall preclude the performance of routine visual screening.

    (((5))) (3) The practice of dentistry or dental hygiene as defined in chapters 18.32 and 18.29 RCW respectively.  The exemptions set forth in RCW 18.32.030 (1) and (8), shall not apply to a physician assistant.

    (((6))) (4) The practice of chiropractic as defined in chapter 18.25 RCW including the adjustment or manipulation of the articulations of the spine.

    (((7))) (5) The practice of podiatric medicine and surgery as defined in chapter 18.22 RCW.

NEW SECTION. Sec. 11.  Sections 1 through 9 of this act constitute a new chapter in Title 18 RCW.

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