Coalition for Patient Access
and Quality Care

NO on SB 323 and SB 622

Proposed Legislation that Puts Patients at RISK and
Increases Health Care COSTS


SB 622: Optometrists

Under this bill, optometrists would be able to perform
eyelid surgery using scalpels ("minor procedures") and surgery for glaucoma and after cataract surgery using lasers.

The specified training for these privileges would be very limited (32 minor procedure training procedures; 24 laser training procedures, 8 of each type).

Although the bill would technically “limit” removal of lesions the optometrist “evaluated” to be non-cancerous, there is a significant potential for such evaluations to be WRONG, resulting in either possibly promoting spread of the cancer by either improper removal or delay in diagnosis and treatment.

With regard to glaucoma lasers, these are not “simple” procedures. Overtreatment can cause pressure in the eye to actually
rise (by damaging the drainage structures that are the target of treatment), which is the opposite of the desired pressure-lowing effect.

With regard to laser surgery after cataract surgery (called a “posterior capsulotomy,” which opens a cloudy membrane that forms over your vision), the need to use excess laser energy/pulses because someone with limited training hasn’t yet learned to place them “efficiently”) can increase the risk of a post-operative pressure “spike,” particularly important in glaucoma patients who are sensitive to high eye pressure.

Medical doctors who specialize in the eyes do HUNDREDS of surgical training procedures on live human patients before practicing independently. Optometrists should be required to do substantial and meaningful numbers of such procedures before being allowed to operate on the eyes of the citizens of California.

SB 323: Nurse Practitioners

Discards existing successful model of medical doctor-led health care teams
Under this bill, Nurse practitioners will be licensed to practice medicine in many settings. NPs will no longer be required to heed standardized protocols and procedures or to work in conjunction with a supervising physician. Doctors, nurse practitioners, and other health care providers have worked in harmony for decades and have a long history of working closely together in health care teams led by physicians. 

This model creates efficiency by allowing each member of the team to contribute the specialized training they have received and are licensed to perform.  The goal of this approach is to deliver accurate, high-quality care to patients.  


With seven or more years of postgraduate education and thousands of hours of clinical experience, doctors are best qualified to lead the health care team.  Their education, clinical training, and continuing medical education ensures that they are well equipped to diagnose and treat patients.  Their experience as administrators also facilitates the integration of a fully coordinated, quality-focused and patient-centered health care team.


Allowing nurse practitioners the ability to independently prescribe medication and diagnose and treat patients without input from a supervising physician undercuts the team-based approach and increases patient risk, inefficiency, and health care costs.

Fails to close the provider gap

It is true that certain communities have many health care providers, while others have none. The number of doctors in California is unevenly distributed in relation to its population. SB 491 won’t solve this problem. 


Just as fewer doctors are going into primary care, fewer health professionals are practicing medicine in low-income and rural communities. 


In comparing where primary care doctors and nurse practitioners choose to work, the American Medical Association (AMA) found that both doctors and nurse practitioners tend to operate in the same, large urban areas. 


This explains why there is both a nursing shortage and a doctor shortage in California.  In fact, the American Association of Colleges of Nursing (AACN) has projected a nationwide shortage of 260,000 nurses by 2025.  Meanwhile, the Association of American Medical Colleges has projected a similar shortage of 130,000 doctors by 2025.   


Instead of increasing access to quality care, this merely sets up a two-tier heath care system where low-income and rural communities will have to settle for a lower standard of care.  This is not the kind of health care reform envisioned by Californians who supported the Affordable Care Act.

CLICK HERE to view information and analyses on SB 323 from the website of the California State Legislature.