Amended in Senate April 6, 2015

Senate Bill No. 525

Introduced by Senator Nielsen

February 26, 2015

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

LEGISLATIVE COUNSEL’S DIGEST

SB 525, as amended, 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. begin insert Existing law provides for the registration and regulation of certified polysomnographic technologists by the Medical Board of California. Under existing law governing polysomnographic technologists, the practice of polysomnography is defined to include the treatment, management, diagnostic testing, control, education, and care of patients with sleep and wake disorders. Existing law governing polysomnographic technologists exempts from those provisions, among others, respiratory care practitioners working within the scope of practice of their license. end insert

This bill would provide that begin delete the scope of practice end delete begin insert associated aspects of cardiopulmonary and other systems functions end insert includes patients with deficiencies and abnormalities affecting the heart and cardiovascular system. The bill would begin delete expand the scope of practice end delete begin insert further define the respiratory care practice end insert 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 begin delete and end delete begin insert , end insert all forms of specified life support begin insert , and the treatment, management, diagnostic testing, control, education, and care of patients with sleep and wake disorders end insert . 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.

(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 begin insert , end insert 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 begin insert , as needed end insert .

begin delete

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:

(1) Direct and indirect pulmonary care services that are safe,
aseptic, preventive, and restorative to the patient.

(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.

(3) Observation and monitoring of signs and symptoms, general
behavior, general physical response to respiratory care treatment
and diagnostic testing and (A) determination of whether such signs,
symptoms, reactions, behavior, or general response exhibits
abnormal characteristics; (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.

(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.

(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.

end delete

begin delete SEC. 3. end delete
begin insert SEC. 2. end insert   

Section 3702.7 of the Business and Professions Code
is amended to read:

begin delete

3702.7.  

In addition to the matters described in Section 3702,
respiratory care as a practice also includes the following:

end delete

begin insert

begin insert 3702.7. end insert   

end insert begin insert

The respiratory care practice is further defined and
includes, but is not limited to, the following:

end insert

(a) Mechanical or physiological ventilatory support as used in begin delete paragraph (4) of end delete subdivision begin delete (a) end delete begin insert (d) end insert 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 begin delete (ECCO(2)R). end delete begin insert (ECCO2R). end insert

(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.

begin insert

(e) “Associated aspects of cardiopulmonary and other systems
functions,” as used in Section 3702, includes patients with
deficiencies and abnormalities affecting the heart and
cardiovascular system.

end insert begin insert

(f) The treatment, management, diagnostic testing, control,
education, and care of patients with sleep and wake disorders as
provided in Chapter 7.8 (commencing with Section 3575).

end insert

begin delete SEC. 4. end delete
begin insert SEC. 3. end insert   

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.