SB 525, as introduced, Nielsen. Respiratory care practice.
Existing law, the Respiratory Care Practice Act, provides for the licensure and regulation of the practice of respiratory therapy. A violation of the act is a crime.
Existing law declares it is the intent of the Legislature to recognize the existence of overlapping functions between physicians and surgeons, registered nurses, physical therapists, respiratory care practitioners, and other licensed health care personnel, and to permit additional sharing of functions within organized health care systems, as specified. Existing law also states that nothing in the act shall be construed to authorize a respiratory care practitioner to practice medicine, surgery, or any other form of healing, except as authorized by the act.
This bill would define, for intent purposes, “overlapping functions” to include providing therapy, management, rehabilitation, diagnostic evaluation, and care for nonrespiratory-related diagnoses or conditions provided certain requirements are met.
Under existing law, respiratory care as a practice means a health care profession employed under the supervision of a medical director in the therapy, management, rehabilitation, diagnostic evaluation, and care of patients with deficiencies and abnormalities which affect the pulmonary system and associated aspects of cardiopulmonary and other systems functions, and includes, among other things, direct and indirect pulmonary care services that are safe, aseptic, preventive, and restorative to the patient.
This bill would provide that the scope of practice includes patients with deficiencies and abnormalities affecting the heart and cardiovascular system. The bill would expand the scope of practice to include, among other things, the administration of medical gases and pharmacological agents for the purpose of inducing conscious or deep sedation under specified supervision and direct orders and all forms of specified life support. By changing the definition of a crime, the bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.
The people of the State of California do enact as follows:
Section 3701 of the Business and Professions
2Code is amended to read:
begin insert(a)end insertbegin insert end insertThe Legislature finds and declares that the practice
4of respiratory care in California affects the public health, safety,
5and welfare and is to be subject to regulation and control in the
6public interest to protect the public from the unauthorized and
7unqualified practice of respiratory care and from unprofessional
8conduct by persons licensed to practice respiratory care. The
9Legislature also recognizes the practice of respiratory care to be
10a dynamic and changing art and science, the practice of which is
11continually evolving to include newer ideas and more sophisticated
12techniques in patient care.
13It
end delete
14begin insert (b)end insertbegin insert end insertbegin insertItend insert is the intent of the Legislature in this chapter to provide
15clear legal authority for functions and procedures which have
16common acceptance and usage. It is the intent also to recognize
17the existence of overlapping functions between physicians and
18surgeons, registered nurses, physical therapists, respiratory care
19practitioners, and other licensed health care personnel, and to
20permit additional sharing of functions within organized health care
P3 1systems. The organized health care systems include, but are not
2limited to, health facilities licensed pursuant to Chapter 2
3(commencing with Section 1250) of Division 2 of the Health and
4Safety Code, clinics, home health agencies, physicians’ offices,
5and public or community health services.
6(c) For purposes of this section, it is the intent of the Legislature
7that “overlapping functions” includes, but is not limited to,
8providing therapy, management, rehabilitation, diagnostic
9evaluation and care for nonrespiratory-related diagnoses or
10conditions provided (1) a health care facility has authorized the
11respiratory care practitioner to provide these services and (2) the
12respiratory care practitioner has maintained current competencies
13in the services provided.
Section 3702 of the Business and Professions Code is
15amended to read:
begin insert(a)end insertbegin insert end insertRespiratory care as a practice means a health care
17profession employed under the supervision of a medical director
18in the therapy, management, rehabilitation, diagnostic evaluation,
19and care of patients with deficiencies and abnormalities which
20affect the pulmonary system and associated aspects of
21cardiopulmonary and other systems functions, and includes all of
22the following:
23(a)
end delete
24begin insert(1)end insert Direct and indirect pulmonary care services that are safe,
25aseptic, preventive, and restorative to the patient.
26(b)
end delete
27begin insert(2)end insert Direct and indirect respiratory care services, including, but
28not limited to, the administration of pharmacological and diagnostic
29and therapeutic agents related to respiratory care procedures
30necessary to implement a treatment, disease prevention, pulmonary
31rehabilitative, or diagnostic regimen prescribed by a physician and
32surgeon.
33(c)
end delete
34begin insert(3)end insert Observation and monitoring of signs and symptoms, general
35behavior, general physical response to respiratory care treatment
36and diagnostic testing andbegin delete (1)end deletebegin insert (A)end insert determination of whether such
37signs, symptoms, reactions, behavior, or general response exhibits
38abnormal characteristics;begin delete (2)end deletebegin insert (B)end insert implementation based on observed
39abnormalities of appropriate reporting or referral or respiratory
40care protocols, or changes in treatment regimen, pursuant to a
P4 1prescription by
a physician and surgeon or the initiation of
2emergency procedures.
3(d)
end delete
4begin insert(4)end insert The diagnostic and therapeutic use of any of the following,
5in accordance with the prescription of a physician and surgeon:
6administration of medical gases, exclusive of general anesthesia;
7aerosols; humidification; environmental control systems and
8baromedical therapy; pharmacologic agents related to respiratory
9care procedures; mechanical or physiological ventilatory support;
10bronchopulmonary hygiene; cardiopulmonary resuscitation;
11maintenance of the natural airways; insertion without cutting tissues
12and maintenance of artificial airways; diagnostic and testing
13techniques required for implementation
of respiratory care
14protocols; collection of specimens of blood; collection of specimens
15from the respiratory tract; analysis of blood gases and respiratory
16secretions.
17(e)
end delete
18begin insert(5)end insert The transcription and implementation of the written and
19verbal orders of a physician and surgeon pertaining to the practice
20of respiratory care.
21“Respiratory care protocols” as used in this section means
22policies and protocols developed by a licensed health facility
23through collaboration, when appropriate, with administrators,
24physicians and surgeons, registered nurses, physical therapists,
25respiratory care practitioners, and other licensed health care
26
practitioners.
27(b) “Associated aspects of cardiopulmonary and other systems
28functions” includes patients with deficiencies and abnormalities
29affecting the heart and cardiovascular system.
Section 3702.7 of the Business and Professions Code
31 is amended to read:
begin deleteMechanical end deletebegin insertIn addition to the matters described in
33Section 3702, respiratory care as a practice also includes the
34following:end insert
35begin insert(a)end insertbegin insert end insertbegin insertMechanicalend insert or physiological ventilatory support as used in
36begin delete subdivision (d)end deletebegin insert paragraph
(4) of subdivision (a)end insert of Section 3702
37includes, but is not limited to, any system, procedure, machine,
38catheter, equipment, or other device used in whole or in part, to
39provide ventilatory or oxygenating support.
P5 1(b) Administration of medical gases and pharmacological agents
2for the purpose of inducing conscious or deep sedation under
3physician and surgeon supervision and the direct orders of the
4physician and surgeon performing the procedure.
5(c) All forms of extracorporeal life support, including, but not
6limited to, extracorporeal membrane oxygenation (ECMO) and
7extracorporeal carbon dioxide removal (ECCO(2)R).
8(d) Educating students, health care professionals, or consumers
9about respiratory care,
including, but not limited to, education of
10respiratory core courses or clinical instruction provided as part
11of a respiratory educational program and educating health care
12professionals or consumers about the operation or application of
13respiratory care equipment and appliances.
No reimbursement is required by this act pursuant to
15Section 6 of Article XIII B of the California Constitution because
16the only costs that may be incurred by a local agency or school
17district will be incurred because this act creates a new crime or
18infraction, eliminates a crime or infraction, or changes the penalty
19for a crime or infraction, within the meaning of Section 17556 of
20the Government Code, or changes the definition of a crime within
21the meaning of Section 6 of Article XIII B of the California
22Constitution.
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