AN ACT Relating to respiratory care and licensing of respiratory care practitioners; amending RCW 18.130.040; reenacting and amending RCW 18.120.020; adding a new chapter to Title 18 RCW; making an appropriation; and providing an effective date.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1. The legislature finds that it is necessary to regulate the practice of respiratory care at the level of licensing in order to protect the public health and safety. It is the legislature's intent that only individuals who meet and maintain minimum standards of competence and conduct provide service to the public. The settings for these services may include, health facilities licensed in this state, clinics, home health agencies, physicians' offices, and public or community health services.

NEW SECTION. Sec. 2. Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.

(1) "Department" means the department of licensing.

(2) "Director" means the director of licensing.

(3) "Respiratory care practitioner" means an individual licensed under this chapter.

(4) "Board" means the Washington state respiratory care board.

(5) "Respiratory care protocols" means policies and procedures developed in a licensed health care facility or by a licensed physician to guide the performance of respiratory care.

NEW SECTION. Sec. 3. (1) No person may engage in the practice of respiratory care as a respiratory care practitioner without first applying for and receiving a license to practice.

(2) A respiratory care practitioner is a person who adopts or uses any title, or any description of services which incorporates one or more of the following terms or designations: (a) RT, (b) RCP, (c) respiratory care, (d) respiratory care practitioner, (e) respiratory therapist, (f) respiratory technician, or (g) inhalation therapist.

NEW SECTION. Sec. 4. (1) A respiratory care practitioner licensed under this chapter is employed in the treatment, management, diagnostic testing, rehabilitation, and care of patients with deficiencies and abnormalities which affect the cardiopulmonary system and associated aspects of other systems, under the direct order of a physician licensed under the laws of this state. The practice of respiratory care includes, but is not limited to:

(a) The use and administration of medical gases, exclusive of general anesthesia;

(b) The use of air and oxygen administering apparatus;

(d) The administration of prescribed pharmacologic agents related to respiratory care;

(e) The use of mechanical or physiological ventilatory support;

(f) Postural drainage, chest percussion and vibration;

(g) Bronchopulmonary hygiene;

(h) Cardiopulmonary resuscitation;

(i) The maintenance of natural and artificial airways and insertion, without cutting tissues, of artificial airways, as ordered by the attending licensed physician;

(j) Diagnostic and monitoring techniques such as the measurement of cardiorespiratory volumes, pressures and flows; and

(k) The drawing and analyzing of arterial, capillary, and mixed venous blood specimens as ordered by the attending licensed physician.

(2) The board may further define by rule the scope of practice in keeping with the training received by the profession.

NEW SECTION. Sec. 5. Nothing in this chapter prohibits or restricts:

(1) The practice of a profession by individuals who are licensed under other laws of this state who are performing services within their authorized scope of practice, which may overlap the services provided by respiratory care practitioners;

(2) The practice of respiratory care by an individual employed by the government of the United States while the individual is engaged in the performance of duties prescribed for him or her by the laws and regulations of the United States;

(3) The practice of respiratory care by a person who is a regular student in a school approved by the board. The performance of such services shall be pursuant to a regular course of instruction or assignments from an instructor, and under the general supervision of this instructor;

(4) Self-care by a patient or gratuitous care by a friend or member of the family who does not represent himself or herself as a respiratory care practitioner; or

(5) Delivery and set-up of home oxygen and respiratory supplies by durable medical equipment suppliers, as prescribed by a licensed physician.

NEW SECTION. Sec. 6. (1) In addition to any other authority provided by law, the director may:

(a) Adopt rules, in accordance with chapter 34.04 RCW, necessary to implement this chapter;

(b) Set all license, examination, and renewal fees in accordance with RCW 43.24.086;

(d) Issue a license to any applicant who has met the education, training, and examination requirements for licensure;

(e) Hire clerical, administrative, and investigative staff as needed to implement this chapter and hire individuals licensed under this chapter to serve as examiners for any practical examinations.

(2) The provisions of chapter 18.130 RCW shall govern the issuance and denial of licenses, and the disciplining of licensees under this chapter. The director shall be the disciplining authority under this chapter.

NEW SECTION. Sec. 7. In addition to any other authority provided by law, the board may:

(1) Adopt rules after discussion and approval of the director, in accordance with chapter 34.04 RCW, which are necessary to implement this chapter;

(2) Evaluate and designate those schools from which graduation will be accepted as proof of an applicant's eligibility to take the licensing examination;

(3) Prepare, grade, and administer, or determine the nature of, and supervise the grading and administration of, examinations for applicants for licensure;

(4) Determine whether alternative methods of training are equivalent to formal education and establish forms, procedures, and criteria for evaluation of an applicant's alternative training to determine the applicant's eligibility to take the examination;

(5) Determine which states have licensing requirements equivalent to those of this state and issue licenses to individuals licensed in those state without examination; and

(6) Define and approve any experience requirement for licensure.

NEW SECTION. Sec. 8. The director shall keep an official record of all proceedings, a part of which record shall consist of a register of all applicants for licensure under this chapter, with the result of each application.

NEW SECTION. Sec. 9. (1) There is created a state respiratory care board consisting of five members appointed by the director. Three members of the board shall be respiratory care practitioners who are licensed under this chapter: PROVIDED, That the initial members may be appointed to the board if they meet all the requirements for licensure under this chapter and have been engaged in the practice of respiratory care for at least five years. One member of the board shall be an individual who is unaffiliated with the profession. One member of the board shall be a physician licensed under chapter 18.71 or 18.57 RCW, who is the medical director for a respiratory care training program, an association that provides respiratory care, or a hospital-based respiratory care department. Each member shall hold office for a term of four years, except that any member appointed to fill a vacancy occurring prior to the expiration of the term for which his predecessor was appointed shall be appointed for the remainder of such term and the terms of office of the members first taking office shall expire, as designated at the time of appointment, one at the end of the first year, one at the end of the second year, one at the end of the third year, and two at the end of the fourth year after the date of appointment. Thereafter all appointments shall be for four years. Any board member may be removed for just cause. The director may appoint a new member to fill any vacancy on the board for the remainder of the unexpired term. No board member may serve more than two consecutive terms, whether full or partial.

(2) Board members shall be entitled to be compensated in accordance with RCW 43.03.240, and to be reimbursed for travel expenses under RCW 43.03.050 and 43.03.060.

(3) The board shall have the authority to annually elect a chairperson and vice-chairperson to direct the meetings of the board. The board shall meet at least once each year, and may hold additional meetings as called by the director or the chairperson. Three members of the board shall constitute a quorum.

NEW SECTION. Sec. 10. The director, members of the board, or individuals acting on their behalf are immune from suit in any action, civil or criminal based on any licensing or disciplinary proceedings, or other official acts performed in the course of their duties.

NEW SECTION. Sec. 11. The director shall issue a license to any applicant who demonstrates to the director's satisfaction, that the following requirements have been met:

(1) Graduation from a school approved by the board or successful completion of alternate training which meets the criteria established by the board;

(2) Successful completion of an examination administered or approved by the board;

(3) Successful completion of any experience requirement established by the board;

(4) Good moral character.

In addition, applicants shall be subject to the grounds for denial or issuance of a conditional license under chapter 18.130 RCW.

The director shall establish by rule what constitutes adequate proof of meeting the criteria.

NEW SECTION. Sec. 12. (1) A person holding a license to perform respiratory care may use the title, "respiratory care practitioner" and the abbreviation, "RCP".

(2) A licensee shall show his or her license when requested.

NEW SECTION. Sec. 13. The board shall establish by rule the standards and procedures for approval of schools and alternate training, and shall have the authority to contract with individuals or organizations having expertise in the profession, or in education, to assist in evaluating those applying for approval. The standards and procedures set shall apply equally to schools and training within the United States and those in foreign jurisdiction.

NEW SECTION. Sec. 14. (1) The date and location of the examination shall be established by the director. Applicants who have been found by the director to meet the other requirements for licensure shall be scheduled for the next examination following the filing of the application. However, the applicant shall not be scheduled for any examination taking place sooner than sixty days after the application is filed.

(2) The board, or its designee, shall examine each applicant, by means determined most effective, on subjects appropriate to the scope of practice. Such examinations shall be limited to the purpose of determining whether the applicant possesses the minimum skill and knowledge necessary to practice competently, and must meet generally accepted standards of fairness and validity for licensing examination.

(3) All examinations shall be conducted by the board, and all grading of the examinations shall be under fair and wholly impartial methods.

(4) Any applicant who fails to make the required grade in the first examination is entitled to take up to three subsequent examinations, upon the prepayment of a fee determined by the director as provided in RCW 43.24.086 for each subsequent examination. Upon failure of four examinations, the director may invalidate the original application and require such remedial education prior to admittance to future examinations as is deemed necessary.

(5) The board may approve an examination prepared and administered by a private testing agency or association of licensing boards for use by an applicant in meeting the licensing requirement.

NEW SECTION. Sec. 15. Applications for licensure shall be submitted on forms provided by the director. The director may require any information and documentation which reasonably relates to the need to determine whether the applicant meets the criteria for licensure provided in this chapter, and chapter 18.130 RCW. Each applicant shall pay a fee determined by the director as provided in RCW 43.24.086, which shall accompany the application.

NEW SECTION. Sec. 16. The director shall waive the examination and grant a license to a person engaged in the profession of respiratory care in the state of Washington on the effective date of this act, if the director determines the person meets commonly accepted standards of education and experience for the profession and has previously achieved an acceptable grade on an approved examination administered by a private testing agency, or respitory care association as established by rule of the board. This section shall only apply to those individuals who file an application for waiver of examination within one year of the effective date of this act.

If an individual is engaged in the practice of respiratory care on the effective date of this act but has not achieved an acceptable grade on such an examination, the individual may apply to the board for examination.

NEW SECTION. Sec. 17. The director shall establish by rule the requirements and fees for renewal of licenses. Failure to renew shall invalidate the license and all privileges granted by the license. In the event a license has lapsed for a period longer than three years, the licensee shall demonstrate competence to the satisfaction of the director by continuing education, or under the other standards determined by the director.

Sec. 18. Section 2, chapter 168, Laws of 1983 as amended by section 18, chapter 9, Laws of 1984 and by section 57, chapter 279, Laws of 1984 and RCW 18.120.020 are each reenacted and amended to read as follows:

The definitions contained in this section shall apply throughout this chapter unless the context clearly requires otherwise.

(1) "Applicant group" includes any health professional group or organization, any individual, or any other interested party which proposes that any health professional group not presently regulated be regulated or which proposes to substantially increase the scope of practice of the profession.

(2) "Certificate" and "certification" mean a voluntary process by which a statutory regulatory entity grants recognition to an individual who (a) has met certain prerequisite qualifications specified by that regulatory entity, and (b) may assume or use "certified" in the title or designation to perform prescribed health professional tasks.

(3) "Grandfather clause" means a provision in a regulatory statute applicable to practitioners actively engaged in the regulated health profession prior to the effective date of the regulatory statute which exempts the practitioners from meeting the prerequisite qualifications set forth in the regulatory statute to perform prescribed occupational tasks.

(4) "Health professions" means and includes the following health and health-related licensed or regulated professions and occupations: Podiatry under chapter 18.22 RCW; chiropractic under chapters 18.25 and 18.26 RCW; dental hygiene under chapter 18.29 RCW; dentistry under chapter 18.32 RCW; dispensing opticians under chapter 18.34 RCW; hearing aids under chapter 18.35 RCW; drugless healing under chapter 18.36 RCW; embalming and funeral directing under chapter 18.39 RCW; midwifery under chapter 18.50 RCW; nursing home administration under chapter 18.52 RCW; optometry under chapters 18.53 and 18.54 RCW; ocularists under chapter 18.55 RCW; osteopathy and osteopathic medicine and surgery under chapters 18.57 and 18.57A RCW; pharmacy under chapters 18.64 and 18.64A RCW; medicine under chapters 18.71, 18.71A, and 18.72 RCW; emergency medicine under chapter 18.73 RCW; physical therapy under chapter 18.74 RCW; practical nurses under chapter 18.78 RCW; psychologists under chapter 18.83 RCW; registered nurses under chapter 18.88 RCW; occupational therapists licensed pursuant to chapter 18.59 RCW; respiratory care practitioners licensed pursuant to chapter 18.-- RCW (sections 1 through 17 of this 1985 act); veterinarians and animal technicians under chapter 18.92 RCW; and massage practitioners under chapter 18.108 RCW.

(5) "Inspection" means the periodic examination of practitioners by a state agency in order to ascertain whether the practitioners' occupation is being carried out in a fashion consistent with the public health, safety, and welfare.

(6) "Legislative committees of reference" means the standing legislative committees designated by the respective rules committees of the senate and house of representatives to consider proposed legislation to regulate health professions not previously regulated.

(7) "License", "licensing", and "licensure" mean permission to engage in a health profession which would otherwise be unlawful in the state in the absence of the permission. A license is granted to those individuals who meet prerequisite qualifications to perform prescribed health professional tasks and for the use of a particular title.

(8) "Professional license" means an individual, nontransferable authorization to carry on a health activity based on qualifications which include: (a) Graduation from an accredited or approved program, and (b) acceptable performance on a qualifying examination or series of examinations.

(9) "Practitioner" means an individual who (a) has achieved knowledge and skill by practice, and (b) is actively engaged in a specified health profession.

(10) "Public member" means an individual who is not, and never was, a member of the health profession being regulated or the spouse of a member, or an individual who does not have and never has had a material financial interest in either the rendering of the health professional service being regulated or an activity directly related to the profession being regulated.

(11) "Registration" means the formal notification which, prior to rendering services, a practitioner shall submit to a state agency setting forth the name and address of the practitioner; the location, nature and operation of the health activity to be practiced; and, if required by the regulatory entity, a description of the service to be provided.

(12) "Regulatory entity" means any board, commission, agency, division, or other unit or subunit of state government which regulates one or more professions, occupations, industries, businesses, or other endeavors in this state.

(13) "State agency" includes every state office, department, board, commission, regulatory entity, and agency of the state, and, where provided by law, programs and activities involving less than the full responsibility of a state agency.

Sec. 19. Section 4, chapter 279, Laws of 1984 and RCW 18.130.040 are each amended to read as follows:

(1) This chapter applies only to the director and the boards having jurisdiction in relation to the professions licensed under the chapters specified in this section. This chapter does not apply to any business or profession not licensed under the chapters specified in this section.

(2) (a) The director has authority under this chapter in relation to the following professions:

(i) Dispensing opticians licensed under chapter 18.34 RCW;

(ii) Drugless healers licensed under chapter 18.36 RCW;

(iii) Midwives licensed under chapter 18.50 RCW;

(iv) Ocularists licensed under chapter 18.55 RCW;

(v) Psychologists licensed under chapter 18.83 RCW unless a disciplinary committee is established under chapter 18.83 RCW;

(vi) Massage operators and businesses licensed under chapter 18.108 RCW; ((~~and~~))

(vii) Dental hygienists licensed under chapter 18.29 RCW; and (viii) Respiratory care practitioners licensed under chapter 18.-- RCW (sections 1 through 17 of this 1985 act).

(b) The boards having authority under this chapter are as follows:

(i) The podiatry board as established in chapter 18.22 RCW;

(ii) The chiropractic disciplinary board as established in chapter 18.26 RCW governing licenses issued under chapter 18.25 RCW;

(iii) The dental disciplinary board as established in chapter 18.32 RCW;

(iv) The council on hearing aids as established in chapter 18.35 RCW;

(v) The board of funeral directors and embalmers as established in chapter 18.39 RCW;

(vi) The board of examiners for nursing home administrators as established in chapter 18.52 RCW;

(vii) The optometry board as established in chapter 18.54 RCW governing licenses issued under chapter 18.53 RCW;

(viii) The board of osteopathic medicine and surgery as established in chapter 18.57 RCW governing licenses issued under chapters 18.57 and 18.57A RCW;

(ix) The medical disciplinary board as established in chapter 18.72 RCW governing licenses and registrations issued under chapters 18.71 and 18.71A RCW;

(x) The board of physical therapy as established in chapter 18.74 RCW;

(xi) The board of occupational therapy practice as established in chapter 18.59 RCW;

(xii) The board of practical nursing as established in chapter 18.78 RCW;

(xiii) The board of nursing as established in chapter 18.88 RCW; ((~~and~~))

(xiv) The veterinary board of governors as established in chapter 18.92 RCW; and

(xv) The respiratory care board as established by chapter 18.-- RCW (sections 1 through 17 of this 1985 act).

(3) In addition to the authority to discipline license holders, the disciplining authority has the authority to grant or deny licenses based on the conditions and criteria established in this chapter and the chapters specified in subsection (2) of this section. However, the board of chiropractic examiners has authority over issuance and denial of licenses provided for in chapter 18.25 RCW, the board of dental examiners has authority over issuance and denial of licenses provided for in RCW 18.32.040, and the board of medical examiners has authority over issuance and denial of licenses and registrations provided for in chapters 18.71 and 18.71A RCW. This chapter governs any investigation, hearing, or proceeding relating to denial of licensure by the disciplining authority, the board of chiropractic examiners, the board of dental examiners, and the board of medical examiners, if adopted pursuant to this chapter by the disciplinary authority.

NEW SECTION. Sec. 20. Sections 1 through 17 of this act shall constitute a new chapter in Title 18 RCW.

NEW SECTION. Sec. 21. There is appropriated from the health professions account in the state general fund to the department of licensing for the biennium ending June 30, 1987, the sum of .......... dollars, or so much thereof as may be necessary, to carry out the purposes of this act.

NEW SECTION. Sec. 22. This act shall take effect six months after it is signed into law.

NEW SECTION. Sec. 23. If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.