BILL ANALYSIS Ó
SB 525
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Date of Hearing: June 23, 2015
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Susan Bonilla, Chair
SB 525(Nielsen) - As Amended June 16, 2015
SENATE VOTE: 34-0
SUBJECT: Respiratory care practice.
SUMMARY: Clarifies the scope of practice for respiratory care
practitioners (RCPs) to include current practices by updating
the legislative intent provisions and updating the definition of
respiratory care practice.
EXISTING LAW:
1)States it is the intent of the Legislature to, among other
things: (BPC § 3701)
a) Provide clear legal authority for functions and
procedures which have common acceptance and usage among
RCPs;
b) Recognize the existence of overlapping functions between
RCPs and other licensed health care personnel; and,
c) To permit additional sharing of functions within
organized health care systems.
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2)States that the Respiratory Care Practice Act (Act) may not be
construed as authorizing a RCP to practice medicine, surgery,
or any other form of healing, except as specified. (BCP §
3705)
3)Defines the practice of 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 that affect the pulmonary system and
associated aspects of cardiopulmonary and other systems
functions. (BPC § 3702)
4)Establishes the Respiratory Care Board of California (RCB) to
administer and enforce the Act. (BPC § 3710)
THIS BILL:
1)States 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
that a health care facility has authorized the RCP to provide
the services and the RCP has maintained current competencies
in the services provided.
2)Defines "associated aspects of cardiopulmonary and other
systems functions" to include patients with deficiencies and
abnormalities affecting the heart and cardiovascular system.
3)Expands the definition of respiratory care practice to
include:
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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
extracorporeal membrane oxygenation (ECMO) and
extracorporeal carbon dioxide removal (ECCO2R);
c) The treatment, management, diagnostic testing, control,
education, and care of patients with sleep and wake
disorders, as specified; and,
d) Educating students, health care professionals, or
consumers about respiratory care, including:
i) Education of respiratory core courses or clinical
instruction provided as part of a respiratory educational
program; and,
ii)Educating health care professionals or consumers about
the operation or application of respiratory care
equipment and appliances.
4)Makes other conforming, nonsubstantive changes.
FISCAL EFFECT: According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS:
Purpose. This bill is co-sponsored by the RCB and the Society
for Respiratory Care . According to the author, "This bill
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. Those
areas include: conscious/deep sedation, extracorporeal life
support; cardiovascular system, respiratory care education,
sleep/wake disorders and overlapping functions.
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Advancements in the medical field, terminology, and the delivery
of care have rapidly evolved since the [Act] was enacted 33
years ago in 1982. Since then, the [RCB] has not made any
legislative or regulatory amendments affecting its scope of
practice with the exception of one in 2004. The [RCB] is
contacted frequently with various 'scope of practice' questions.
And while the [RCB] 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 [RCPs]."
Background. As noted above, the RCB often receives scope of
practice questions because the scope of practice for RCP's has
only been updated once in 33 years. While the intent behind the
Act is to recognize the existence of overlapping functions
between RCPs and other healing arts professions, the authorized
functions are not outlined-they must be gleaned from the
existing categories of authorized practices and checked against
the restrictions in the other professions.
This bill seeks to codify existing authorized practices. The
RCB regularly authorizes the practices included in this bill
with legislative authors' letters of intent, a 1990 Legislative
Counsel opinion, and other expert opinions.
Practices to be Codified. According to the author, this bill
will allow a RCP to:
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 a RCP with current competencies.
The author states that the legislative intent section will allow
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a 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 a 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, but not general anesthesia.
According to the author, RCPs have been performing conscious and
deep sedation for decades. This procedure is performed for
pulmonary doctors during a bronchoscopy, a procedure to view
the airways and treat or diagnose lung disease.
3)Perform extracorporeal (external) life support, including
extracorporeal membrane oxygenation (ECMO) and extracorporeal
CO2 removal (ECCO2R).
ECMO is a type of partial cardiopulmonary bypass-it uses a pump
to circulate blood through an artificial lung back into the
bloodstream. The treatment is used to support the lungs,
heart, or both for patients in intensive care with reversible
life threatening respiratory or cardiac disease. One form of
ECMO, ECCO2R, uses an ECMO circuit to remove carbon dioxide
from the body, which provides partial respiratory support.
A 1990 Legislative Counsel opinion stated that ECMO is within a
RCP's scope of practice.
4)Educate students, health care professionals, and consumers
about respiratory care.
Educators of respiratory educational courses and respiratory
equipment must be licensed, but the author's office believes
the statute needs clarification.
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5)Provide specified care to patients with 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, 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.
Polysomnography, is a multi-parametric test used for sleep
medicine and sleep studies. In an effort to protect sleeping
patients and test subjects, SB 132 (Denham), Chapter 635,
Statutes of 2009, created a certification requirement for
polysomnographic technologists under the Medical Board of
California. As a result, polysomnography is often administered
by polysomnographic technicians.
While SB 132 was not meant to prohibit RCPs from practicing
polysomnography, the statute is ambiguous. A letter of intent
from the SB 132'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 a RCP's scope. This bill clarifies a RCPs
scope.
ARGUMENTS IN SUPPORT:
The RCB (co-sponsor) writes in support, "Advancements in the
medical field and the delivery of care have rapidly evolved
since the [Act] was enacted 33 years ago in 1982. The [RCB] is
contacted frequently with various 'scope of practice' questions.
And while the [RCB] has opined or even moved forward with
expert opinions on many of these inquiries, confusion exists
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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."
The California Society for Respiratory Care (co-sponsor) writes
in support, "Since its inception thirty three years ago, the
Respiratory Care Act has been updated just once in 2004. SB 525
updates the act to include current competencies and practices?.
Making these changes to the statute will address a variety of
questions the RCB receives from healthcare facilities, consumers
and RCPs about the practice of respiratory care."
ARGUMENTS IN OPPOSITION:
None on file.
REGISTERED SUPPORT:
Respiratory Care Board of California (co-sponsor)
California Society for Respiratory Care (co-sponsor)
REGISTERED OPPOSITION:
None on file.
Analysis Prepared by:Vincent Chee / B. & P. / (916) 319-3301
SB 525
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