PRINTER'S NO. 1241
No. 1093 Session of 1989
INTRODUCED BY SAURMAN, J. L. WRIGHT, VROON, MORRIS, NAHILL,
VEON, E. Z. TAYLOR, J. TAYLOR, McVERRY, TRELLO, BUNT,
J. H. CLARK AND WILSON, APRIL 10, 1989
REFERRED TO COMMITTEE ON PROFESSIONAL LICENSURE, APRIL 10, 1989
AN ACT
1 Establishing and regulating the practice of respiratory care;
2 imposing penalties; and making an appropriation.
3 TABLE OF CONTENTS
4 Section 1. Short title.
5 Section 2. Statement of purpose.
6 Section 3. Definitions.
7 Section 4. Creation of committee, method of appointment and
8 term of office.
9 Section 5. Powers and duties of committee.
10 Section 6. Certificate required.
11 Section 7. Persons and practices not affected.
12 Section 8. Requirements for certification.
13 Section 9. Examination.
14 Section 10. Waiver of certain requirements for certification.
15 Section 11. Use of title.
16 Section 12. Practice of respiratory care.
17 Section 13. Unlawful acts.
1 Section 14. Renewal of certificate; suspension or revocation.
2 Section 15. Refusal, suspension or revocation of certificate;
3 refusal to renew.
4 Section 16. Fees.
5 Section 17. Penalties.
6 Section 18. Injunctive relief.
7 Section 19. Appropriation.
8 Section 20. Effective date.
9 The General Assembly of the Commonwealth of Pennsylvania
10 hereby enacts as follows:
11 Section 1. Short title.
12 This act shall be known and may be cited as the Respiratory
13 Care Practice Act.
14 Section 2. Statement of purpose.
15 The General Assembly finds and declares that the practice of
16 respiratory care in Pennsylvania affects the public health,
17 safety and welfare and is to be subject to regulation and
18 control in the public interest to protect the public from the
19 unauthorized and unqualified practice of respiratory care and
20 from unprofessional conduct by persons certified to practice
21 respiratory care.
22 Section 3. Definitions.
23 The following words and phrases when used in this act shall
24 have the meanings given to them in this section unless the
25 context clearly indicates otherwise:
26 "Board." The State Board of Medicine within the Bureau of
27 Professional and Occupational Affairs.
28 "Certification." The process an individual undergoes to
29 receive a written declaration, legally authenticated, verifying
30 as being of the standard quality and preparation required by the
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1 committee.
2 "Committee." The Committee for the Practice of Respiratory
3 Care within the State Board of Medicine.
4 "Commissioner." The Commissioner of Professional and
5 Occupational Affairs.
6 "Medical director of respiratory care." A licensed physician
7 who is a board-eligible or board-certified pulmonologist or a
8 board-certified anesthesiologist or an anesthesiologist in the
9 examination system or an internist who devotes a predominance of
10 practice to pulmonary medicine designated by a health care
11 facility or health care agency to assure the quality, safety and
12 appropriateness of its respiratory care services.
13 "Respiratory care." A health care specialty employing
14 evaluation, analysis, care and treatment of patients with
15 cardiopulmonary disorders and related diseases.
16 "Respiratory care practitioner." A natural person who is
17 certified under this act to practice respiratory care.
18 "Respiratory care training program." A program accredited or
19 recognized by the American Medical Association's Committee on
20 Allied Health Education and Accreditation.
21 Section 4. Creation of committee, method of appointment and
22 term of office.
23 (a) Creation of committee.--There is hereby created the
24 Committee for the Practice of Respiratory Care under the State
25 Board of Medicine. It shall consist of eight individuals as
26 follows:
27 (1) Three physicians, licensed to practice in this
28 Commonwealth, all of whom shall be medical directors of
29 respiratory care services, none of whom need be members of
30 the board.
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1 (2) Three certified respiratory care practitioners, each
2 of whom shall have practiced respiratory care for a minimum
3 of 36 months. The three initial representative appointees
4 shall be qualified to receive certification under this act.
5 (3) One public member.
6 (4) The commissioner, or his designee, who shall serve
7 as an ex officio member.
8 (b) Appointments to the committee.--
9 (1) The chairman of the board shall appoint the members
10 to serve on the committee.
11 (2) In appointing persons to fill vacancies in the three
12 committee positions designated to be held by certified
13 respiratory care practitioners, the board shall select
14 respiratory care practitioners who reside in different
15 regions of this Commonwealth. The Society of Respiratory
16 Managers and/or the Pennsylvania Society for Respiratory
17 Therapy, Inc., or that body which represents the respiratory
18 care profession in this Commonwealth shall submit a list of
19 names of qualified respiratory care practitioners willing to
20 serve on the committee for the board's consideration. The
21 Pennsylvania Society for Pulmonary Medicine, or that body
22 which represents pulmonary physicians in this Commonwealth,
23 shall submit a list of names of qualified physicians willing
24 to serve on the committee for the board's consideration.
25 (c) Term of office.--
26 (1) The term of office of appointed members shall be
27 three years, except the initial respiratory care practitioner
28 members and the initial physician members appointed shall
29 serve terms as follows:
30 (i) One member from each of these two categories --
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1 three years each.
2 (ii) One member from each of these two categories --
3 two years each.
4 (iii) One member from each of these two categories
5 -- one year each.
6 (2) A member appointed to fill a vacancy occurring other
7 than by expiration of a term shall be appointed for the
8 remainder of the unexpired term.
9 (3) Members of the committee shall be eligible for
10 reappointment. Members shall receive reimbursement for
11 reasonable expenses incurred while engaged in the discharge
12 of official duties, as well as an initial per diem allowance
13 of $30 which may be increased or reduced from time to time by
14 action of the Executive Board of the Commonwealth.
15 (d) Meetings.--
16 (1) The committee shall meet at least three times yearly
17 and may hold additional meetings whenever necessary, subject
18 to the approval of the board, to discharge its duties.
19 (2) The location of the meetings shall be determined by
20 the committee, subject to the approval of the board, but
21 shall be within this Commonwealth.
22 Section 5. Powers and duties of committee.
23 (a) Elections.--The committee shall elect annually, from its
24 membership, a chairperson, a vice chairperson and a secretary. A
25 quorum shall be a majority of the voting members.
26 (b) Examinations and applicants.--It shall be the duty of
27 the board, upon recommendation from the committee, to pass upon
28 the qualifications of the applicants for certification, conduct
29 examinations, establish passing criteria for the examination,
30 and issue and renew certificates to respiratory care
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1 practitioners.
2 (c) Adverse actions.--The board, upon recommendation from
3 the committee, shall be authorized and empowered to refuse,
4 revoke or suspend a certificate of a respiratory care
5 practitioner. Pursuant to this act, the board, upon
6 recommendation from the committee, shall be empowered to conduct
7 investigations, including the power to issue subpoenas and hold
8 hearings upon charges or information indicating violations of
9 the provisions of this act or regulations promulgated pursuant
10 thereto.
11 (d) Regulations.--The board, upon recommendation from the
12 committee, shall have the power to promulgate and adopt rules
13 and regulations, subject to the approval of the commissioner, as
14 it deems necessary to the performance of its duties and the
15 proper administration of this act.
16 (e) Forms and fees.--The board, upon recommendation from the
17 committee, shall develop such forms and establish such fees as
18 deemed appropriate.
19 (f) Additional requirements--The board, upon recommendation
20 from the committee, shall establish additional requirements for
21 certificate renewal designed to assure continued competency.
22 Section 6. Certificate required.
23 (a) Practice.--It shall be unlawful, two years after the
24 effective date of this act, for any person to practice or to
25 indicate an ability to practice respiratory care unless
26 certified under the provisions of this act.
27 (b) Use of title.--A person shall not use the title
28 "Respiratory Care Practitioner" or any title as it relates to
29 the practice of respiratory care unless certified in accordance
30 with the requirements set forth in this act. A health care
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1 institution, health care service, health plan or other
2 institution shall not hold itself out as providing respiratory
3 care services unless the respiratory care services provided by
4 it are performed by a person certified under this act.
5 Section 7. Persons and practices not affected.
6 This act shall not be construed as preventing or restricting
7 the practices, services or activities of:
8 (1) A person licensed or certified by the Commonwealth
9 to provide health care services, including, but not limited
10 to, physicians, osteopaths, physical therapists,
11 chiropractors, nurses, dentists, physician assistants and
12 podiatrists.
13 (2) A person rendering respiratory care services
14 pursuant to his employment by a Federal agency.
15 (3) A person pursuing a course of study leading to a
16 degree or certificate in respiratory care in an accredited or
17 approved educational program, provided he demonstrates
18 satisfactory progress in that program, is designated by a
19 title which clearly indicates the status of student or
20 trainee and not a certified respiratory care practitioner and
21 provides respiratory care under supervision.
22 (4) A person who has passed an examination certified by
23 the National Commission of Health Certifying Agencies in a
24 specialty which relates to respiratory care.
25 (5) A person acting upon the instructions of a
26 physician, by prescription, certificate of medical necessity
27 or otherwise, who delivers, installs, monitors, maintains or
28 provides services only with respect to a device which enables
29 an individual to self-administer respiratory care.
30 Section 8. Requirements for certification.
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1 An applicant applying for the examination as a respiratory
2 care practitioner shall submit a written application on forms
3 provided by the committee evidencing to the satisfaction of the
4 committee that he:
5 (1) is of good moral character; and
6 (2) (i) has completed the academic requirements of a
7 respiratory care training program as defined in this act;
8 or
9 (ii) has provided respiratory care as defined in
10 this act for at least 12 months prior to the enactment of
11 this act, but who is not designated as a "Certified
12 Respiratory Therapy Technician" or "Registered
13 Respiratory Therapist" by the National Board for
14 Respiratory Care, Inc.
15 Section 9. Examination.
16 (a) Requirements.--Any person meeting the requirements of
17 section 8 may submit an application for examination.
18 (b) Frequency.--The committee shall conduct examinations for
19 certification of respiratory care practitioners no less than two
20 times per year in such geographical locations as are deemed
21 advantageous to the majority of applicants.
22 (c) Type.--The examination given for respiratory care
23 practitioners shall be the same as or equivalent to that given
24 by the National Board for Respiratory Care, Inc., for Entry
25 Level Certification of Respiratory Therapy Technicians. The
26 committee shall annually review the examination and standards.
27 Each applicant who achieves the score established by the
28 committee shall be entitled to certification as a respiratory
29 care practitioner.
30 (d) Prohibition.--The committee shall not issue a
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1 certificate to an applicant who is under investigation in
2 another jurisdiction for an offense which would constitute a
3 violation of this act.
4 Section 10. Waiver of certain requirements for certification.
5 The committee shall issue a certificate without examination
6 to:
7 (1) A person filing an application within two years from
8 the effective date of this act who presents evidence
9 satisfactory to the committee that, prior to the effective
10 date of this act, the applicant was a certified respiratory
11 therapy technician or a registered respiratory therapist, as
12 certified or registered by the National Board for Respiratory
13 Care, Inc., or held an equivalent credential acceptable to
14 the committee and practiced within this Commonwealth on the
15 effective date of this act.
16 (2) A person who presents evidence satisfactory to the
17 committee of being certified, licensed or registered as a
18 respiratory care practitioner by another state, the District
19 of Columbia, or a territory of the United States or being a
20 certified respiratory therapy technician or a registered
21 respiratory therapist, as certified or registered by the
22 National Board for Respiratory Care, Inc., and practicing in
23 another state, the District of Columbia or a territory of the
24 United States where the requirements for licensure,
25 registration or certification on the date of his licensure,
26 registration or certification were substantially equal to the
27 requirements set forth in this act.
28 Section 11. Use of title.
29 Only an individual who is issued a certificate as a
30 respiratory care practitioner under the provisions of this act
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1 may use the title "Respiratory Care Practitioner" or "Certified
2 Respiratory Care Practitioner" and the letters "RCP" or "C-RCP"
3 in connection with the title or place of business to denote his
4 certification under the provisions of this act.
5 Section 12. Practice of respiratory care.
6 A certified respiratory care practitioner may:
7 (1) Implement direct respiratory care to an individual
8 only upon:
9 (i) physician prescription, certificate of medical
10 necessity or referral;
11 (ii) upon approval by a physician, standing orders,
12 protocols or care plans; or
13 (iii) under medical direction and approval by an
14 institution's physician governing body, standing orders,
15 protocols or care plans.
16 (2) Enter a case for the providing of indirect services,
17 consultation or evaluation of an individual as to the need
18 for respiratory care services, provided, however, that direct
19 respiratory care may only be performed pursuant to paragraph
20 (1).
21 Section 13. Unlawful acts.
22 It shall be unlawful for anyone who is not certified or
23 exempt under the terms of this act to hold himself out to the
24 public as performing any of the following:
25 (1) Administration of medical gases.
26 (2) Humidity and aerosol therapy.
27 (3) Administration of aerosolized medications.
28 (4) Intermittent positive pressure breathing.
29 (5) Incentive spirometry.
30 (6) Bronchopulmonary hygiene.
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1 (7) Management and maintenance of natural airways.
2 (8) Maintenance and insertion of artificial airways.
3 (9) Cardiopulmonary rehabilitation.
4 (10) Management and maintenance of mechanical
5 ventilation.
6 (11) Measurement of ventilatory flows, volumes and
7 pressures.
8 (12) Analysis of ventilatory gases and blood gases.
9 (13) Monitoring of cardiovascular hemodynamics.
10 Section 14. Renewal of certificate; suspension or revocation.
11 (a) Renewal.--A certificate issued under this act shall be
12 renewed biannually upon payment of the renewal fee prescribed in
13 section 16. The certificate shall expire unless renewed in the
14 manner prescribed by the regulation of the committee. The
15 committee may provide for the late renewal of a certificate upon
16 the payment of a late fee. A late renewal of a certificate shall
17 not be granted more than 18 months after its expiration. A
18 certificate shall be renewed after the 18-month period only by
19 complying with section 9. The committee may establish additional
20 educational requirements for certificate renewal designed to
21 assure continued competency of the applying and renewing
22 respiratory care practitioners.
23 (b) Suspended certificate.--A suspended certificate shall
24 expire at the end of its term and may be renewed as provided in
25 this section. The renewal shall not authorize the certificate
26 holder, while the certificate remains suspended, to engage in
27 the prescribed activities or in any other activities in
28 violation of the order or judgment by which the certificate was
29 suspended. Whenever a certificate revoked on disciplinary
30 grounds is reinstated, the certificate holder, as a condition of
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1 reinstatement, shall pay a renewal fee and any late fee that may
2 be applicable.
3 Section 15. Refusal, suspension or revocation of certificate;
4 refusal to renew.
5 (a) Refusal.--The committee may refuse to issue a
6 certificate or, after notice and hearing, may suspend, revoke or
7 refuse to renew a certificate or may impose probationary
8 conditions if the certificate holder or applicant for
9 certification is guilty of conduct which has endangered or is
10 likely to endanger the health, welfare or safety of the public.
11 Such conduct shall include, but not be limited to, the
12 following:
13 (1) Obtaining a license by means of fraud,
14 misrepresentation or concealment of material facts.
15 (2) Violation of this act or regulations adopted by the
16 committee.
17 (3) Being convicted of a crime, other than a summary
18 offense or a misdemeanor of the third degree, which is found
19 by the committee to have a direct bearing on whether the
20 person should be entrusted to serve the public as a
21 respiratory care practitioner.
22 (4) Carrying out or administering any modality or
23 physician prescription, order, referral or protocol which, in
24 the opinion of the certificate holder, is an unethical
25 practice or is likely to endanger the health, welfare or
26 safety of the patient.
27 (b) Procedures.--Actions of the committee shall be taken
28 subject to the right of notice, hearing and adjudication, and
29 the right of appeal in accordance with the provisions of Title 2
30 of the Pennsylvania Consolidated Statutes (relating to
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1 administrative law and procedure).
2 Section 16. Fees.
3 The committee shall determine all necessary fees subject to
4 the approval of the commissioner. Fees shall be collected by the
5 committee through the Bureau of Professional and Occupational
6 Affairs and shall be paid into the Professional Licensure
7 Augmentation Account established pursuant to and for use in
8 accordance with the act of July 1, 1978 (P.L.700, No.124), known
9 as the Bureau of Professional and Occupational Affairs Fee Act.
10 Section 17. Penalties.
11 A person who violates a provision of this act commits a
12 misdemeanor of the third degree and shall, upon conviction, be
13 sentenced to pay a fine of not less than $100 or to imprisonment
14 for not more than 90 days, or both. For each additional offense,
15 the person shall be subject to a fine of not less than $500 or
16 to imprisonment for less than six months, at the discretion of
17 the court. Fines collected under the provisions of this act
18 shall be paid into the State Treasury for the use of the
19 Commonwealth.
20 Section 18. Injunctive relief.
21 Injunctive relief may be applied for in any court of
22 competent jurisdiction to enjoin a person from committing an act
23 in violation of this act. The injunction proceedings shall be in
24 addition to, not in lieu of, all penalties and other remedies in
25 this act.
26 Section 19. Appropriation.
27 The sum of $90,000, or as much thereof as may be necessary,
28 is hereby appropriated from the Professional Licensure
29 Augmentation Account within the General Fund of the Bureau of
30 Professional and Occupational Affairs for the establishment and
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1 operation of the Committee for the Practice of Respiratory Care.
2 The appropriation granted shall be repaid by the committee
3 within three years of issuance of certificates by the committee.
4 Section 20. Effective date.
5 This act shall take effect in 90 days.
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