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
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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
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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
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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
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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
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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
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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
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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
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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.
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