BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 525|
|Office of Senate Floor Analyses | |
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CONSENT
Bill No: SB 525
Author: Nielsen (R)
Amended: 4/6/15
Vote: 21
SENATE BUS, PROF. & ECON. DEV. COMMITTEE: 9-0, 4/13/15
AYES: Hill, Bates, Berryhill, Block, Galgiani, Hernandez,
Jackson, Mendoza, Wieckowski
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SUBJECT: Respiratory care practice
SOURCE: Respiratory Care Board of California
DIGEST: This bill clarifies and updates the Respiratory Care
Act to conform to current practices.
ANALYSIS:
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
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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)
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)
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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.
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.
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.
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, at
which time a Committee omnibus bill, SB 1913 (Committee on
Business and Professions, Chapter 695, Statutes of 2004)
clarified the meaning of "mechanical or physiological ventilator
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support." This bill is intended to align current practices with
statutory authorization.
This bill authorizes an RCP to do the following:
1) 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.
2) 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.
3) 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.
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.
4) Educate students, health care professionals, and consumers
about respiratory care.
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Educators of core respiratory educational courses and
respiratory equipment must be licensed, but the author's
office believes the statute needs clarification.
5) 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.
6) 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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
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SUPPORT: (Verified4/28/15)
Respiratory Care Board of California (source)
California Society for Respiratory Care
OPPOSITION: (Verified 4/28/15)
None received
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."
Prepared by:Sarah Huchel / B., P. & E.D. / (916) 651-4104
4/29/15 16:07:30
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