California Politics: A sleeper bill on Newsom’s desk to keep an eye on

A woman, left, receives an eye exam from an optometrist at his office in Compton in 2010.
Sophia Taylor of Long Beach receives an eye exam from Dr. Jay H. Messinger at the optometrist’s office in Compton in 2010.
(Christina House / Los Angeles Times)

Thousands of bills pass through the California Legislature each year, a whirlwind of proposals that typically wind their way through committee hearings and debates on the Senate and Assembly floors. By the time the final night of legislative action arrives, reporters know which bills they are keeping an eye on to see whether they make it to the governor’s desk.

And then, occasionally, a bill that has largely remained off the radar silences the back of the legislative chamber, where reporters hunch over laptops.

That’s what happened with Assembly Bill 2236.

The sleeper bill is just starting to garner attention after narrowly passing the state Legislature a week ago, despite its supporters — and even opponents — saying it will affect all Californians who value their eyesight. If that’s for the better depends on whether you ask an optometrist or ophthalmologist for clarity.

Let me explain.

An ophthalmologist is a physician whose focus is on surgery and management of complex eye diseases. Optometrists have a narrower scope of practice, examining and diagnosing vision related issues, including eye infections, prescribing glasses and contact lenses, and managing some diseases of the eye.


AB 2236 would expand what procedures an optometrist can perform in California with additional training. It’s one of 571 bills currently on Gov. Gavin Newsom’s desk. The governor has until Sept. 30 to sign or veto those bills, which also includes a doctor transparency measure that had previously struggled to gain traction the last two years. More on that bill later.

The scope of the scope bill

Optometrists and other supporters say AB 2236 would address a critical need in the state to reduce wait times for specialty eye care, adding that there are 13 counties in California without an ophthalmologist and six more with just one. For patients who use Medi-Cal, it’s even more difficult to find an ophthalmologist who accepts the state’s health program for people with low incomes, supporters said.

“We have no place to send these patients — they have to wait months and months or actually go without the care,” said Jeffrey Garcia, an optometrist in the Central Valley and member of the California State Board of Optometry. “This bill is definitely an access to care bill.”

Critics, however, say increasing the scope of practice for lesser-trained medical professionals to do more complex procedures only further puts patients at risk. And they pushed back against the claim that vast swaths of the state have no access. Nearly 98% of the state’s population is within a 30-minute drive to an ophthalmologist, according to data from the American Academy of Ophthalmology.

AB 2236, which is authored by Assemblymember Evan Low (D-Campbell), would allow optometrists to perform certain laser and surgical procedures that supporters described as minimally invasive after completing additional education and certification. Low, whose father is an optometrist, said the bill will “empower and help uplift our communities” by allowing an “optometrist to do what they’re mainly trained to be able to do.”

Opponents, which include the California Medical Assn., say the training standards in the bill are not sufficient.

“When it comes to eye surgery, the margins of safety are narrow, and surgical mishaps can be difficult or impossible to reverse,” said Dr. Robert E. Wailes, president of the California Medical Assn.

Under the bill, an optometrist could perform a procedure called corneal crosslinking, which is used to treat keratoconus, a condition in which the cornea gradually bulges outward and distorts vision. The procedure involves removing the thin surface tissue of the eye and applying medication and ultraviolet light.


“They try to paint these procedures as simple and that’s not the case,” said Dr. Craig Kliger, a San Francisco ophthalmologist and executive vice president of the California Academy of Eye Physicians and Surgeons. “They all have vision-threatening complications.”

‘It would have changed my life’

Although the complexity of the optometrist scope of practice bill is clear, AB 1278 seems innocuous. The bill requires doctors to post a notice in their office letting patients know that there is a federal database where they can search whether a physician has financial ties to a drug or medical device company. A patient would also be notified about the Open Payments database during their initial office visit through a written or electronic notice.

But, for Wendy Knecht, the bill has been a hard-fought battle that began when she was diagnosed in December 2014 with the BRCA2 gene mutation and a subsequent decision to reduce her risk of breast cancer by having a preventive double mastectomy. That surgery left Knecht, a former Pan Am flight attendant and now a Studio City writer, with nerve damage and in chronic pain.

She later learned her Pasadena plastic surgeon, Dr. Max Lehfeldt, used a device that was not approved for breast reconstruction at the time. The maker of that device had paid Lehfeldt more than $400,000 over a three-year period to research and promote it.

Knecht filed a malpractice lawsuit, contending Lehfeldt used the device and failed to inform her of its “off-label” use because of his financial relationship with its maker. Lehfeldt and his insurance company settled the lawsuit for $1 million, without admitting liability.

But, Knecht said the entire painful fiasco could have been avoided if she knew the doctor had a paid relationship with the device maker.

“In my case, it would have changed my life,” she said. “I would not have agreed to having this device put inside me.”

The Medical Board of California accused Lehfeldt of repeated negligent acts in his care of patients, including Knecht, with potential disciplinary action pending. Knecht’s fight for a transparency bill was featured in The Times’ investigative series about the state medical board’s pattern of leniency in disciplinary cases against doctors and the powerful physicians lobby that has worked against reform efforts.

Last year, when AB 1278 was first introduced, the bill sought to have doctors who receive payments from a drug and medical device company to disclose the relationship to patients. However, the bill was watered down over the past two legislative sessions amid opposition from the doctors lobby, the California Medical Assn.

The association contends the bill “diverts crucial patient time to administrative tasks that do not improve patient care.”

Assemblymember Adrin Nazarian (D-North Hollywood), who authored AB 1278, said the bill is “fundamentally about transparency.”

“This bill will ensure patients are aware of the federal reporting database that already exists for our doctors and surgeons so that they have the tools they need to make better informed decisions about their health,” Nazarian said.

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