PRINTER'S NO. 3007
No. 2088 Session of 2007
INTRODUCED BY ADOLPH, YUDICHAK, BARRAR, KILLION, BRENNAN, CLYMER, GEORGE, HENNESSEY, W. KELLER, R. MILLER, MILNE, MOYER, MUNDY, MURT, MUSTIO, O'NEILL, PALLONE, PAYNE, PETRI, REICHLEY, ROSS, RUBLEY, SAYLOR, SEIP, SONNEY, J. TAYLOR AND WATSON, DECEMBER 11, 2007
REFERRED TO COMMITTEE ON PROFESSIONAL LICENSURE, DECEMBER 11, 2007
AN ACT 1 Amending the act of October 5, 1978 (P.L.1109, No.261), entitled 2 "An act requiring the licensing of practitioners of 3 osteopathic medicine and surgery; regulating their practice; 4 providing for certain funds and penalties for violations and 5 repeals," further providing for definitions, for the State 6 Board of Osteopathic Medicine, for respiratory care 7 practitioners, for respiratory care practitioner certificates 8 and permits and for reasons for refusal, revocation or 9 suspension of license; and providing for regulations. 10 The General Assembly of the Commonwealth of Pennsylvania 11 hereby enacts as follows: 12 Section 1. The definitions of "board-regulated practitioner" 13 and "respiratory care practitioner" in section 2 of the act of 14 October 5, 1978 (P.L.1109, No.261), known as the Osteopathic 15 Medical Practice Act, amended or added July 2, 1993 (P.L.418, 16 No.59) and December 10, 2001 (P.L.863, No.93), are amended to 17 read: 18 Section 2. Definitions. 19 The following words and phrases when used in this act shall
1 have, unless the context clearly indicates otherwise, the 2 meanings given to them in this section: 3 * * * 4 "Board-regulated practitioner." An osteopathic physician, 5 physician assistant, respiratory [care practitioner] therapist 6 or certified athletic trainer or an applicant for a license or 7 certificate issued by the board. 8 * * * 9 "Respiratory [care practitioner] therapist." An individual 10 who is [certified] licensed to practice respiratory care by the 11 State Board of Osteopathic Medicine. 12 * * * 13 Section 2. Section 2.1(a) of the act, amended December 10, 14 2001 (P.L.863, No.93), is amended to read: 15 Section 2.1. State Board of Osteopathic Medicine. 16 (a) The State Board of Osteopathic Medicine shall consist of 17 the Commissioner of Professional and Occupational Affairs or his 18 designee; the Secretary of Health or his designee; two members 19 appointed by the Governor who shall be persons representing the 20 public at large; one member appointed by the Governor who shall 21 be a respiratory [care practitioner] therapist, a physician 22 assistant or a certified athletic trainer; and six members 23 appointed by the Governor who shall be graduates of a legally 24 incorporated and reputable college of osteopathy and shall have 25 been licensed to practice osteopathic medicine under the laws of 26 this Commonwealth and shall have been engaged in the practice of 27 osteopathy in this Commonwealth for a period of at least five 28 years. All professional and public members of the board shall be 29 appointed by the Governor with the advice and consent of a 30 majority of the members elected to the Senate. The Governor 20070H2088B3007 - 2 -
1 shall assure that respiratory [care practitioners] therapists, 2 physician assistants and certified athletic trainers on a 3 rotating basis. 4 * * * 5 Section 3. Section 10.1 of the act, added July 2, 1993 6 (P.L.418, No.59), is amended to read: 7 Section 10.1. Respiratory [care practitioners] therapists. 8 [(a) Eighteen months after the effective date of this 9 section, it shall be unlawful for any person to hold himself out 10 to the public as a respiratory care practitioner and to practice 11 or offer to practice respiratory care unless he holds a valid, 12 current temporary permit or certificate issued by the board. 13 (b) A respiratory care practitioner who holds a valid, 14 current temporary permit or certificate issued by the board may 15 use the title respiratory care practitioner or respiratory care 16 practitioner-certified or an appropriate abbreviation of that 17 title, such as "R.C.P." or "R.C.P.-C."] 18 (a) An individual shall be eligible to apply for licensure 19 as a respiratory therapist if that individual satisfies all of 20 the following: 21 (1) Submits evidence satisfactory to the board, on forms 22 approved by the board, that the applicant has met one or more 23 of the following criteria: 24 (i) Has graduated from a respiratory care program 25 approved by the Committee on Accreditation for 26 Respiratory Care and passed the entry level examination 27 as determined by the National Board for Respiratory Care. 28 (ii) Holds a valid license, certificate or 29 registration as a respiratory therapist in another state, 30 territory or the District of Columbia which has been 20070H2088B3007 - 3 -
1 issued based on requirements substantially similar to 2 those required by this Commonwealth, including having 3 successfully passed an examination. 4 (2) Has paid the licensure fee as established by the 5 board by regulation. 6 (3) Has proved to the satisfaction of the board that the 7 individual is of good moral character and is not unfit or 8 unable to practice as a respiratory therapist by reason of 9 physical or mental impairment. 10 (a.1) It shall be unlawful for any individual to hold 11 himself out to the public as a respiratory therapist or to 12 practice or offer to practice respiratory care unless the 13 individual holds a valid, current license issued by the board or 14 the State Board of Medicine. 15 (a.2) It shall be unlawful for an individual to use the 16 title of "licensed respiratory therapist" or to use the letters 17 "L.R.T." or "R.T." or to hold oneself out as a licensed 18 respiratory therapist unless that individual is licensed to 19 practice respiratory care as provided under this act or the act 20 of December 20, 1985 (P.L.457, No.112), known as the Medical 21 Practice Act of 1985. 22 (b) For a period of two years following the effective date 23 of this subsection, an individual shall be eligible to apply for 24 licensure without examination if the individual meets the 25 qualifications for licensure under section 10.2 and holds valid 26 certification as a respiratory care practitioner as issued by 27 the board or the State Board of Medicine. 28 (c) The board is authorized to promulgate regulations to 29 implement this section. 30 (d) A respiratory [care practitioner certified] therapist 20070H2088B3007 - 4 -
1 licensed by the board may implement direct respiratory care to
2 an individual being treated by either a licensed medical doctor
3 or a licensed doctor of osteopathic medicine upon physician
4 prescription or referral or under medical direction and approval
5 consistent with standing orders or protocols of an institution
6 or health care facility. This care may constitute indirect
7 services, such as consultation or evaluation of an individual,
8 and also includes, but is not limited to, the following
9 services:
10 (1) Administration of medical gases.
11 (2) Humidity and aerosol therapy.
12 (3) Administration of aerosolized medications.
13 (4) Intermittent positive pressure breathing.
14 (5) Incentive spirometry.
15 (6) Bronchopulmonary hygiene.
16 (7) Management and maintenance of natural airways.
17 (8) Maintenance and insertion of artificial airways.
18 (9) Cardiopulmonary rehabilitation.
19 (10) Management and maintenance of mechanical
20 ventilation.
21 (11) Measurement of ventilatory flows, volumes and
22 pressures.
23 (12) Analysis of ventilatory gases and blood gases.
24 (e) This section shall not prevent or restrict the
25 practices, services or activities of:
26 (1) A person licensed or certified in this Commonwealth
27 to provide another health care service, including, but not
28 limited to, physicians, physical therapists, chiropractors,
29 nurses, dentists, physician assistants and podiatrists.
30 (2) A person rendering respiratory care services
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1 pursuant to employment by a Federal agency. 2 (3) A person pursuing a course of study leading to a 3 degree or certificate in respiratory care in an accredited 4 educational program if he is clearly designated as a student 5 and provides care under supervision implemented through that 6 program. 7 (4) A person executing or conveying medical orders 8 pursuant to lawful delegation by a physician. 9 (5) A person who, pursuant to lawful delegation by a 10 physician, delivers, installs, monitors or maintains a device 11 which enables an individual to self-administer respiratory 12 care. 13 (6) A person qualified by academic and clinical 14 education to operate extracorporeal circulation equipment in 15 a medical or surgical setting which requires support to or 16 the temporary replacement of a patient's circulatory or 17 respiratory functions. 18 (f) Information or allegations filed with the board against 19 a respiratory [care practitioner certified] therapist licensed 20 by the State Board of Medicine shall be referred to that board 21 for appropriate action. 22 Section 4. Section 10.2 of the act, amended or added July 2, 23 1993 (P.L.418, No.59) and July 2, 2004 (P.L.486, No.56), is 24 amended to read: 25 Section 10.2. Respiratory [care practitioner certificates] 26 therapist licenses and permits. 27 (a) A respiratory [care practitioner certificate] therapist 28 license issued by the board empowers the holder to practice 29 respiratory care under the supervision of a licensed medical 30 doctor or a licensed doctor of osteopathic medicine. In a health 20070H2088B3007 - 6 -
1 care facility, that supervision may consist of standing orders 2 or protocols approved by the institution consistent with 3 acceptable and prevailing medical standards which may include 4 services rendered directly to the patient in his home or other 5 residence. 6 (b) The board shall issue temporary permits for the practice 7 of respiratory care to individuals who have applied for 8 [certification] licensure from the board and who meet any of the 9 following requirements: 10 (1) Graduation from an accredited respiratory care 11 training program recognized by the board. 12 (2) Enrollment in an accredited respiratory care 13 training program recognized by the board if the individual is 14 expected to graduate within 30 days from the date of 15 application. 16 (3) [Designation as a "Certified Respiratory Therapist" 17 or a "Registered Respiratory Therapist" by a nationally 18 recognized credentialing agency approved by the board. 19 (4) Continuous provision of respiratory care services 20 for a minimum of 12 months immediately preceding the 21 effective date of this section. 22 (5) Holding certification, licensure or registration as 23 a respiratory care practitioner issued by another state, the 24 District of Columbia or a territory of the United States 25 where the requirements for licensure, registration or 26 certification are substantially similar to those required by 27 the board.] Recognition as a credentialed respiratory 28 therapist as approved by the board. 29 (c) Temporary permits shall be valid for 12 months and for 30 such additional period as the board may, in each case, specially 20070H2088B3007 - 7 -
1 determine, except that a temporary permit shall expire if the 2 holder fails the examination. An appropriate fee for a temporary 3 permit shall be established by the board by regulation. If [he] 4 the temporary permit holder is not in violation of any other 5 provision of this act, a holder of a temporary permit qualifies 6 for admission to the examination and shall apply for the next 7 regularly scheduled [certification] licensure examination 8 administered by the board. The board is authorized to promulgate 9 regulations to establish procedures for application, credentials 10 verification, examination and [certification] licensure, 11 together with appropriate fees. 12 (d) Pursuant to section 812.1 of the act of April 9, 1929 13 (P.L.177, No.175), known as The Administrative Code of 1929, the 14 board shall contract for the development and administration of 15 an examination for the [certification] licensure of respiratory 16 [care practitioners] therapists. [At least one administration of 17 this examination shall be given within 12 months of the 18 effective date of this section, and the] The examination shall 19 [thereafter] be given at least twice per year. [An individual 20 qualifying for a temporary permit under subsection (b)(5) shall 21 be issued a certificate by the board without examination. An 22 individual qualifying for a temporary permit under subsection 23 (b)(3) shall be issued a certificate by the board without 24 examination if the individual passed an examination in order to 25 obtain designation as a "Certified Respiratory Therapy 26 Technician" or a "Registered Respiratory Therapist" and that 27 examination was comparable to the examination developed and 28 administered pursuant to this subsection.] 29 (e) A respiratory [care practitioner certificate] therapist 30 license shall be renewed biennially upon application on a form 20070H2088B3007 - 8 -
1 prescribed by the board and upon payment of a renewal fee 2 adopted by the board by regulation. 3 (f) (1) The board shall adopt, promulgate and enforce rules 4 and regulations consistent with the provisions of this act 5 establishing requirements of continuing education to be met 6 by individuals holding [certification] licensure as 7 respiratory [care practitioners] therapists under this act as 8 a condition for [certificate] biennial license renewal. The 9 regulations shall include any fees necessary for the board to 10 carry out its responsibilities under this section. 11 (2) Beginning with the first biennial license renewal 12 period [designated by regulation, certificate] following 13 promulgation of regulations, license holders shall be 14 required to attend and complete [20] 30 hours of mandatory 15 continuing education during each two-year [certificate] 16 licensure period. At least one credit hour shall be in 17 ethics, and one credit hour shall be in patient safety. 18 (3) An individual applying for the first time for 19 [certification] licensure in this Commonwealth shall be 20 exempted from the continuing education requirement for the 21 biennial renewal period [following initial certification] in 22 which licensure is obtained. 23 (4) [The board may waive all or a portion of the 24 continuing education requirement for biennial renewal for a 25 certificate holder who shows to the satisfaction of the board 26 that the individual was unable to complete the requirements 27 due to serious illness, military service or other 28 demonstrated hardship. The request shall be made in writing, 29 with appropriate documentation, and shall include a 30 description of circumstances sufficient to show why the 20070H2088B3007 - 9 -
1 certificate holder is unable to comply with the continuing 2 education requirement. Waiver requests shall be evaluated by 3 the board on a case-by-case basis. The board shall send the 4 certificate holder written notification of its approval or 5 denial of a waiver request.] The board shall, by regulation, 6 provide for the waiver of continuing education requirements 7 in case of illness, hardship and armed service duties. A 8 request for waiver shall be evaluated on a case-by-case 9 basis. 10 (5) A [certificate holder] licensee seeking to reinstate 11 an inactive or lapsed [certificate] license shall show proof 12 of compliance with the continuing education requirement for 13 the preceding biennium. 14 (6) All courses, locations, instructors and providers 15 shall be approved by the board. No credit shall be given for 16 any course in office management or practice building. 17 [(7) The board shall initiate the promulgation of 18 regulations to carry out the provisions of this section 19 within one year of the effective date of this subsection.] 20 Section 5. Section 15(b) of the act, amended July 2, 2004 21 (P.L.486, No.56), is amended to read: 22 Section 15. Reasons for refusal, revocation or suspension of 23 license. 24 * * * 25 (b) The board shall have authority to refuse, revoke or 26 suspend the license of a physician assistant or respiratory 27 therapist, or the certification of a [respiratory care 28 practitioner or] certified athletic trainer for any or all of 29 the following reasons: 30 (1) Failing to demonstrate the qualification for 20070H2088B3007 - 10 -
1 licensure or certification contained in this act or 2 regulations of the board. 3 (2) Making misleading, deceptive, untrue or fraudulent 4 representations in his serving as a physician assistant; 5 practicing fraud or deceit in obtaining a license to serve as 6 a physician assistant; or making a false or deceptive 7 biennial registration with the board. 8 (3) Conviction of a felony in this Commonwealth or any 9 other state, territory or country. Conviction as used in this 10 paragraph shall include a finding or verdict of guilt, an 11 admission of guilt or a plea of nolo contendere, or receiving 12 probation without verdict, disposition in lieu of trial, or 13 an Accelerated Rehabilitative Disposition in the disposition 14 of felony charges. 15 (4) Having his license to serve as a physician assistant 16 revoked or suspended or having other disciplinary action 17 taken, or his application for licensure refused, revoked or 18 suspended by the proper certifying authority of another 19 state, territory or country. 20 (5) Being unable to serve as a physician assistant with 21 reasonable skill and safety to the physician's patients by 22 reason of illness, drunkenness, excessive use of drugs, 23 narcotics, chemicals, or any other type of material, or as a 24 result of any mental or physical condition. 25 (6) In enforcing paragraph (5), the board shall, upon 26 probable cause, have authority to compel a physician 27 assistant to submit to a mental or physical examination by 28 physicians designated by it. Failure of a physician assistant 29 to submit to such examination shall constitute an admission 30 of the allegations against him unless the failure is due to 20070H2088B3007 - 11 -
1 circumstances beyond his control, consequent upon which a 2 default and final order may be entered without the taking of 3 testimony or presentation of evidence. A physician assistant 4 affected under this paragraph shall at reasonable intervals 5 be afforded an opportunity to demonstrate that he can resume 6 the competent assistance of a physician in the physician's 7 practice of medicine, with reasonable skill and safety to the 8 physician's patients. 9 (7) Violating a lawful regulation promulgated by the 10 board or violating a lawful order of the board, previously 11 entered by the board in a disciplinary proceeding. 12 (8) Knowingly rendering medical care and services except 13 under the supervision and direction of the supervising 14 physician. 15 (9) Being guilty of immoral or unprofessional conduct 16 shall include any departure from, or the failure to conform 17 to, the standards of acceptable and prevailing practice for 18 physician assistants, in which proceeding actual injury to a 19 patient need not be established. 20 * * * 21 Section 6. The State Board of Osteopathic Medicine and the 22 State Board of Medicine shall jointly promulgate regulations to 23 implement the amendment of sections 2, 2.1(a), 10.1, 10.2 and 24 15(b) of the act within 18 months of the effective date of this 25 section. 26 Section 7. This act shall take effect as follows: 27 (1) This section shall take effect immediately. 28 (2) Section 6 of this act shall take effect immediately. 29 (3) The remainder of this act shall take effect in 60 30 days. L11L63BIL/20070H2088B3007 - 12 -