Amended in Assembly June 16, 2015

Amended in Senate April 6, 2015

Senate BillNo. 525


Introduced by Senator Nielsen

February 26, 2015


An act to amend Sections 3701begin insert, 3702, end insert 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 therapybegin insert by the Respiratory Care Board of Californiaend insert. 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 billbegin delete would defineend delete, for intent purposes, begin insertwould define end insert“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. 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.

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

P2    1

SECTION 1.  

Section 3701 of the Business and Professions
2Code
is amended to read:

3

3701.  

(a) The 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
P3    1conduct by persons licensed to practice respiratory care. The
2Legislature also recognizes the practice of respiratory care to be
3a dynamic and changing art and science, the practice of which is
4continually evolving to include newer ideas and more sophisticated
5techniques in patient care.

6 (b) It is the intent of the Legislature in this chapter to provide
7clear legal authority for functions and procedures which have
8common acceptance and usage. It is the intent also to recognize
9the existence of overlapping functions between physicians and
10surgeons, registered nurses, physical therapists, respiratory care
11practitioners, and other licensed health care personnel, and to
12permit additional sharing of functions within organized health care
13systems. The organized health care systems include, but are not
14limited to, health facilities licensed pursuant to Chapter 2
15(commencing with Section 1250) of Division 2 of the Health and
16Safety Code, clinics, home health agencies, physicians’ offices,
17and public or community health services.

18(c) For purposes of this section, it is the intent of the Legislature
19that “overlapping functions” includes, but is not limited to,
20providing therapy, management, rehabilitation, diagnostic
21evaluation, and care for nonrespiratory-related diagnoses or
22conditions provided (1) a health care facility has authorized the
23respiratory care practitioner to provide these services and (2) the
24respiratory care practitioner has maintained current competencies
25in the services provided, as needed.

26begin insert

begin insertSEC. 2.end insert  

end insert

begin insertSection 3702 of the end insertbegin insertBusiness and Professions Codeend insertbegin insert is
27amended to read:end insert

28

3702.  

begin insert(a)end insertbegin insertend insert Respiratory care as a practice means a health care
29profession employed under the supervision of a medical director
30in the therapy, management, rehabilitation, diagnostic evaluation,
31and care of patients with deficiencies and abnormalities which
32affect the pulmonary system and associated aspects of
33cardiopulmonary and other systems functions, and includes all of
34the following:

begin delete

35(a)

end delete

36begin insert(1)end insert Direct and indirect pulmonary care services that are safe,
37aseptic, preventive, and restorative to the patient.

begin delete

38(b)

end delete

39begin insert(2)end insert Direct and indirect respiratory care services, including, but
40not limited to, the administration of pharmacological and diagnostic
P4    1and therapeutic agents related to respiratory care procedures
2necessary to implement a treatment, disease prevention, pulmonary
3rehabilitative, or diagnostic regimen prescribed by a physician and
4surgeon.

begin delete

5(c)

end delete

6begin insert(3)end insert Observation and monitoring of signs and symptoms, general
7behavior, general physical response to respiratory care treatment
8and diagnostic testing andbegin delete (1)end deletebegin insert (A)end insert determination of whether such
9signs, symptoms, reactions, behavior, or general response exhibits
10abnormal characteristics;begin delete (2)end deletebegin insert (B)end insert implementation based on observed
11abnormalities of appropriate reporting or referral or respiratory
12care protocols, or changes in treatment regimen, pursuant to a
13prescription by a physician and surgeon or the initiation of
14emergency procedures.

begin delete

15(d)

end delete

16begin insert(4)end insert The diagnostic and therapeutic use of any of the following,
17in accordance with the prescription of a physician and surgeon:
18administration of medical gases, exclusive of general anesthesia;
19aerosols; humidification; environmental control systems and
20baromedical therapy; pharmacologic agents related to respiratory
21care procedures; mechanical or physiological ventilatory support;
22bronchopulmonary hygiene; cardiopulmonary resuscitation;
23maintenance of the natural airways; insertion without cutting tissues
24and maintenance of artificial airways; diagnostic and testing
25techniques required for implementation of respiratory care
26protocols; collection of specimens of blood; collection of specimens
27from the respiratory tract; analysis of blood gases and respiratory
28secretions.

begin delete

29(e)

end delete

30begin insert(5)end insert The transcription and implementation of the written and
31verbal orders of a physician and surgeon pertaining to the practice
32of respiratory care.

begin insert

33(b) As used in this section, the following apply:

end insert
begin insert

34(1) “Associated aspects of cardiopulmonary and other systems
35functions” includes patients with deficiencies and abnormalities
36affecting the heart and cardiovascular system.

end insert

37begin insert(2)end insertbegin insertend insert “Respiratory care protocols” begin deleteas used in this sectionend delete means
38policies and protocols developed by a licensed health facility
39through collaboration, when appropriate, with administrators,
40physicians and surgeons, registered nurses, physical therapists,
P5    1respiratory care practitioners, and other licensed health care
2practitioners.

3

begin deleteSEC. 2.end delete
4begin insert SEC. 3.end insert  

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

6

3702.7.  

The respiratory care practice is further defined and
7includes, but is not limited to, the following:

8(a) Mechanical or physiological ventilatory support as used in
9begin insertparagraph (4) of end insertsubdivisionbegin delete (d)end deletebegin insert (a)end insert of Section 3702 includes, but
10is not limited to, any system, procedure, machine, catheter,
11equipment, or other device used in whole or in part, to provide
12ventilatory or oxygenating support.

13(b) Administration of medical gases and pharmacological agents
14for the purpose of inducing conscious or deep sedation under
15physician and surgeon supervision and the direct orders of the
16physician and surgeon performing the procedure.

17(c) All forms of extracorporeal life support, including, but not
18limited to, extracorporeal membrane oxygenation (ECMO) and
19extracorporeal carbon dioxide removal (ECCO2R).

20(d) Educating students, health care professionals, or consumers
21about respiratory care, including, but not limited to, education of
22respiratory core courses or clinical instruction provided as part of
23a respiratory educational program and educating health care
24professionals or consumers about the operation or application of
25respiratory care equipment and appliances.

begin delete

26(e) “Associated aspects of cardiopulmonary and other systems
27functions,” as used in Section 3702, includes patients with
28deficiencies and abnormalities affecting the heart and
29cardiovascular system.

30(f)

end delete

31begin insert(e)end insert The treatment, management, diagnostic testing, control,
32education, and care of patients with sleep and wake disorders as
33provided in Chapter 7.8 (commencing with Section 3575).

34

begin deleteSEC. 3.end delete
35begin insertSEC. 4.end insert  

No reimbursement is required by this act pursuant to
36Section 6 of Article XIII B of the California Constitution because
37the only costs that may be incurred by a local agency or school
38district will be incurred because this act creates a new crime or
39infraction, eliminates a crime or infraction, or changes the penalty
40for a crime or infraction, within the meaning of Section 17556 of
P6    1the Government Code, or changes the definition of a crime within
2the meaning of Section 6 of Article XIII B of the California
3Constitution.



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