BILL NUMBER: SB 525	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Nielsen

                        FEBRUARY 26, 2015

   An act to amend Sections 3701, 3702, and 3702.7 of the Business
and Professions Code, relating to healing arts.


	LEGISLATIVE COUNSEL'S DIGEST


   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 1.  Section 3701 of the Business and Professions Code is
amended to read:
   3701.   (a)    The Legislature finds and
declares that the practice of respiratory care in California affects
the public health, safety, and welfare and is to be subject to
regulation and control in the public interest to protect the public
from the unauthorized and unqualified practice of respiratory care
and from unprofessional conduct by persons licensed to practice
respiratory care. The Legislature also recognizes the practice of
respiratory care to be a dynamic and changing art and science, the
practice of which is continually evolving to include newer ideas and
more sophisticated techniques in patient care. 
   It 
    (b)     It  is the intent of the
Legislature in this chapter to provide clear legal authority for
functions and procedures which have common acceptance and usage. It
is the intent also 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. The organized health
care systems include, but are not limited to, health facilities
licensed pursuant to Chapter 2 (commencing with Section 1250) of
Division 2 of the Health and Safety Code, clinics, home health
agencies, physicians' offices, and public or community health
services. 
   (c) For purposes of this section, it is the intent of the
Legislature that "overlapping functions" includes, but is not limited
to, providing therapy, management, rehabilitation, diagnostic
evaluation and care for nonrespiratory-related diagnoses or
conditions provided (1) a health care facility has authorized the
respiratory care practitioner to provide these services and (2) the
respiratory care practitioner has maintained current competencies in
the services provided. 
  SEC. 2.  Section 3702 of the Business and Professions Code is
amended to read:
   3702.   (a)    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
all of the following: 
   (a) 
    (1)  Direct and indirect pulmonary care services that
are safe, aseptic, preventive, and restorative to the patient.

   (b) 
    (2)  Direct and indirect respiratory care services,
including, but not limited to, the administration of pharmacological
and diagnostic and therapeutic agents related to respiratory care
procedures necessary to implement a treatment, disease prevention,
pulmonary rehabilitative, or diagnostic regimen prescribed by a
physician and surgeon. 
   (c) 
    (3)  Observation and monitoring of signs and symptoms,
general behavior, general physical response to respiratory care
treatment and diagnostic testing and  (1)   (A)
 determination of whether such signs, symptoms, reactions,
behavior, or general response exhibits abnormal characteristics;
 (2)   (B)  implementation based on
observed abnormalities of appropriate reporting or referral or
respiratory care protocols, or changes in treatment regimen, pursuant
to a prescription by a physician and surgeon or the initiation of
emergency procedures. 
   (d) 
    (4)  The diagnostic and therapeutic use of any of the
following, in accordance with the prescription of a physician and
surgeon: administration of medical gases, exclusive of general
anesthesia; aerosols; humidification; environmental control systems
and baromedical therapy; pharmacologic agents related to respiratory
care procedures; mechanical or physiological ventilatory support;
bronchopulmonary hygiene; cardiopulmonary resuscitation; maintenance
of the natural airways; insertion without cutting tissues and
maintenance of artificial airways; diagnostic and testing techniques
required for implementation of respiratory care protocols; collection
of specimens of blood; collection of specimens from the respiratory
tract; analysis of blood gases and respiratory secretions. 
   (e) 
    (5)  The transcription and implementation of the written
and verbal orders of a physician and surgeon pertaining to the
practice of respiratory care.
   "Respiratory care protocols" as used in this section means
policies and protocols developed by a licensed health facility
through collaboration, when appropriate, with administrators,
physicians and surgeons, registered nurses, physical therapists,
respiratory care practitioners, and other licensed health care
practitioners. 
   (b) "Associated aspects of cardiopulmonary and other systems
functions" includes patients with deficiencies and abnormalities
affecting the heart and cardiovascular system. 
  SEC. 3.  Section 3702.7 of the Business and Professions Code is
amended to read:
   3702.7.   Mechanical   In addition to the
matters described in Section 3702, respiratory care as a practice
also includes the following: 
    (a)     Mechanical  or physiological
ventilatory support as used in  subdivision (d) 
 paragraph   (4) of subdivision (a) of Section 3702
includes, but is not limited to, any system, procedure, machine,
catheter, equipment, or other device used in whole or in part, to
provide ventilatory or oxygenating support. 
   (b) Administration of medical gases and pharmacological agents for
the purpose of inducing conscious or deep sedation under physician
and surgeon supervision and the direct orders of the physician and
surgeon performing the procedure.  
   (c) All forms of extracorporeal life support, including, but not
limited to, extracorporeal membrane oxygenation (ECMO) and
extracorporeal carbon dioxide removal (ECCO(2)R).  
   (d) Educating students, health care professionals, or consumers
about respiratory care, including, but not limited to, education of
respiratory core courses or clinical instruction provided as part of
a respiratory educational program and educating health care
professionals or consumers about the operation or application of
respiratory care equipment and appliances. 
  SEC. 4.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.