BILL ANALYSIS Ó
SENATE COMMITTEE ON
BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
Senator Jerry Hill, Chair
2015 - 2016 Regular
Bill No: SB 525 Hearing Date: April 13,
2015
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|Author: |Nielsen |
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|Version: |April 6, 2015 |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant|Sarah Huchel |
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Subject: Respiratory care practice.
SUMMARY: Clarifies and updates the Respiratory Care Act to conform to
current practices.
Existing law:
1) Establishes the Respiratory Care Board of California (Board)
to administer and enforce the Respiratory Care Practice Act
(Act). (Business and Professions Code (BPC) §§ 3700 and
3710)
2) Defines "respiratory care" as a health care profession
performed 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. (BPC § 3702)
3) States the intent of the Legislature to provide clear legal
authority for functions and procedures which have common
acceptance and usage among respiratory therapists. It is
also the intent to recognize the existence of overlapping
functions between physicians and surgeons, registered nurses,
physical therapists, respiratory care practitioners (RCPs),
and other licensed health care personnel, and to permit
additional sharing of functions within organized health care
systems. (BPC § 3701)
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4) Establishes approved functions for an RCP. (BCP §§ 3702,
3702.7, and 3705)
5) States that the Act shall not be construed as authorizing an
RCP to practice medicine, surgery, or any other form of
healing, except as authorized by the Act. (BCP § 3705)
This bill:
1)States 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
that a health care facility has authorized the respiratory
care practitioner to provide these services and the RCP has
maintained current competencies in the services provided, as
needed.
2)Expands respiratory care practices to include, but not be
limited to, the following:
a) 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.
b) All forms of extracorporeal life support, including, but
not limited to, extracorporeal membrane oxygenation (ECMO)
and extracorporeal carbon dioxide removal (ECCO2R).
c) Educating students, health care professionals, or
consumers about respiratory care, including, but not
limited to:
i) Education of respiratory core courses or clinical
instruction provided as part of a respiratory educational
program.
ii) Educating health care professionals or consumers
about the operation or application of respiratory care
equipment and appliances.
SB 525 (Nielsen) Page 3
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d) The treatment, management, diagnostic testing, control,
education, and care of patients with sleep and wake
disorders, as specified.
3)Clarifies that "associated aspects of cardiopulmonary and
other systems functions" includes patients with deficiencies
and abnormalities affecting the heart and cardiovascular
system.
FISCAL
EFFECT: Unknown. This bill has been keyed "fiscal" by
Legislative Counsel.
COMMENTS:
1.Purpose. This bill is sponsored by the Respiratory Care Board
of California , which writes that SB 525 "clarifies areas of
the respiratory scope of practice that were not initially
drafted to accommodate advancements in technology and changes
in patient care for future interpretation."
2.Background. Respiratory care is an allied health specialty
which provides a wide range of therapeutic and diagnostic
services to patients with heart and lung disorders.
Respiratory therapists, also known as RCPs, are involved in
the evaluation and monitoring of heart and lung function as
well as giving treatment.
Respiratory therapists work in medical teams to treat all
types of patients, ranging from premature infants whose lungs
are not fully developed to elderly people with lung disease.
More than 34,000 RCP licenses have been issued in the State of
California.
The minimum educational requirements for RCP licensure include
an associate degree with completion of an approved two-year
respiratory care program with clinical practice. There are 33
respiratory care programs throughout California. Most
respiratory care therapists work in hospitals (emergency,
intensive care, neonatal/pediatric units, cardiac care, etc.).
The RCP scope statutes have not been updated since 2004 when a
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Committee omnibus bill, SB 1913 (Committee on Business and
Professions) Chapter 695, Statutes of 2004, clarified the
meaning of "mechanical or physiological ventilator support."
This bill is intended to align current practices with
statutory authorization.
3.Additional Authorized Functions Clarified. As the Author
explains, this bill authorizes an RCP to do the following:
a) Perform non-respiratory care tasks shared with
physicians, registered nurses, physical therapists, and
other licensed healthcare personnel as "overlapping
functions," if a health care facility authorizes an RCP
with current competencies.
According to the Author, the intent of this section is to
allow an RCP who is treating a respiratory care patient to
also provide other services if the RCP is competent and
authorized by the health facility. For example, this would
allow an RCP who is providing respiratory care to a
diabetic cardiac patient to check the patient's sugar
levels.
b) Administer pharmacological agents and medical gases to
induce conscious or deep sedation according to direct
orders and under physician supervision. (This does not
include general anesthesia.)
According to the Author's office, RCPs have been performing
conscious and deep sedation for decades. This procedure is
often performed for pulmonary doctors during a
bronchoscopy, a procedure to view the airways and treat or
diagnose lung disease.
c) Perform all forms of extracorporeal (outside the body)
life support, including ECMO and ECCO2R.
ECMO is a type of cardiopulmonary bypass that supports the
lungs, heart, or both for patients in intensive care with
reversible life threatening respiratory or cardiac disease.
Extracorporeal carbon dioxide elimination (ECCO2R) refers to the
process by which an extracorporeal circuit is used for the
primary purpose of removing carbon dioxide from the body,
thereby providing partial respiratory support.
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A 1990 Legislative Counsel opinion determined that ECMO is
within an RCP's scope of practice. ECMO encompasses ECCO2R, but
ECCO2R is gaining more recognition as familiar terminology.
d) Educate students, health care professionals, and
consumers about respiratory care.
Educators of core respiratory educational courses and
respiratory equipment must be licensed, but the Author's
office believes the statute needs clarification.
e) Provide specified care to patients with deficiencies and
abnormalities affecting the cardiopulmonary and
cardiovascular system.
The cardiopulmonary and cardiovascular systems are intertwined
and share the common goal to deliver oxygen to tissues and
remove carbon dioxide. According to the Author's office, RCPs
possess an in-depth knowledge and understanding of these systems
and work in both cardiovascular and pulmonary laboratories -
which in some instances are the same.
f) Treat, manage, provide diagnostic testing, control,
education, and care for patients with sleep and wake
disorders.
This bill allows RCPs to practice polysomnography, a
multi-parametric test, often administered by
polysomnographic technicians, used in the study of sleep
and as a diagnostic tool in sleep medicine. In an effort
to protect consumers in a vulnerable state, SB 132 (Denham,
Chapter 635, Statutes of 2009) created a registration for
certified polysomnographic technologists, technicians, and
trainees under the Medical Board of California. While this
bill was not meant to prohibit RCPs from polysomnography,
the statute remains ambiguous. A Letter of Intent from the
bill's Author was printed in the Senate Journal on
September 11, 2009 to clarify that some tasks related to
polysomnography should be considered "overlapping
functions," and well within an RCP's scope of practice.
The Board wants this codified to avoid any further
confusion.
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4. Arguments in Support. The Respiratory Care Board of
California writes, "Advancements in the medical field and the
delivery of care have rapidly evolved since the Respiratory
Care Practice Act was enacted 33 years ago in 1982. The
Board is contacted frequently with various 'scope of
practice' questions. And while the Board has opined or even
moved forward with expert opinions on many of these
inquiries, confusion exists among facilities throughout
California of which practices are authorized to be performed
by licensed respiratory care practitioners. Lack of clarity
in the RCP scope of practice can often be a roadblock for
facilities as they attempt to provide the most efficient and
beneficial care to patients."
SUPPORT AND OPPOSITION:
Support:
Respiratory Care Board of California (Sponsor)
California Society for Respiratory Care
Opposition:
None on file as of April 7, 2015
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