H-1283.1 _______________________________________________
HOUSE BILL 1536
_______________________________________________
State of Washington 55th Legislature 1997 Regular Session
By Representatives Backlund, Cody and Dyer
Read first time 01/29/97. Referred to Committee on Health Care.
AN ACT Relating to respiratory care; amending RCW 18.89.010, 18.89.020, 18.89.040, 18.89.050, 18.89.060, 18.89.080, 18.89.090, 18.89.110, 18.89.120, 18.89.140, and 18.120.020; reenacting and amending RCW 18.130.040; adding a new section to chapter 18.89 RCW; repealing RCW 18.89.130 and 18.89.900; providing an effective date; and declaring an emergency.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1. RCW 18.89.010 and 1987 c 415 s 1 are each amended to read as follows:
The
legislature finds that ((it is necessary to regulate the practice of
respiratory care at the level of certification)) in order to ((protect
the public health and safety)) safeguard life, health, and to promote
public welfare, a person practicing or offering to practice respiratory care as
a respiratory care practitioner in this state shall be required to submit
evidence that he or she is qualified to practice, and shall be licensed as
provided. The settings for these services may include, health facilities
licensed in this state, clinics, home care, home health agencies,
physicians' offices, and public or community health services. The
respiratory care practitioner is directly accountable and responsible to the
individual consumer for the quality of respiratory care rendered. Nothing
in this chapter shall be construed to require that individual or group policies
or contracts of an insurance carrier, health care service contractor, or health
maintenance organization provide benefits or coverage for services and supplies
provided by a person certified under this chapter.
NEW SECTION. Sec. 2. A new section is added to chapter 18.89 RCW to read as follows:
After the effective date of this act, it shall be unlawful for a person to practice or to offer to practice as a respiratory care practitioner in this state or to use a title, sign, or device to indicate that such a person is practicing as a respiratory care practitioner unless the person has been duly licensed and registered under the provisions of this chapter.
Sec. 3. RCW 18.89.020 and 1994 sp.s. c 9 s 511 are each amended to read as follows:
Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
(1) "Department" means the department of health.
(2) "Secretary" means the secretary of health or the secretary's designee.
(3)
"Respiratory care practitioner" means an individual ((certified))
licensed under this chapter.
(4) "Physician" means an individual licensed under chapter 18.57 or 18.71 RCW.
(((5)
"Rural hospital" means a hospital located anywhere in the state
except the following areas:
(a)
The entire counties of Snohomish (including Camano Island), King, Kitsap,
Pierce, Thurston, Clark, and Spokane;
(b)
Areas within a twenty-mile radius of an urban area with a population exceeding
thirty thousand persons; and
(c)
Those cities or city-clusters located in rural counties but which for all
practical purposes are urban. These areas are Bellingham, Aberdeen-Hoquiam,
Longview-Kelso, Wenatchee, Yakima, Sunnyside, Richland-Kennewick-Pasco, and
Walla Walla.))
Sec. 4. RCW 18.89.040 and 1994 sp.s. c 9 s 716 are each amended to read as follows:
(1)
A respiratory care practitioner ((certified)) 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, and
is under the direct order and under the qualified medical direction of a
physician. The practice of respiratory care includes, but is not limited to:
(((1)))
(a) The use and administration of prescribed medical gases,
exclusive of general anesthesia;
(((2)))
(b) The use of air and oxygen administering apparatus;
(((3)))
(c) The use of humidification and aerosols;
(((4)))
(d) The administration, to the extent of training, of prescribed
pharmacologic agents related to respiratory care;
(((5)))
(e) The use of mechanical ((or)) ventilatory, hyperbaric, and
physiological ((ventilatory)) support;
(((6)))
(f) Postural drainage, chest percussion, and vibration;
(((7)))
(g) Bronchopulmonary hygiene;
(((8)))
(h) Cardiopulmonary resuscitation as it pertains to ((establishing
airways and external cardiac compression)) advanced cardiac life support
or pediatric advanced life support guidelines;
(((9)))
(i) The maintenance of natural and artificial airways and insertion,
without cutting tissues, of artificial airways, as ((ordered)) prescribed
by ((the attending)) a physician;
(((10)))
(j) Diagnostic and monitoring techniques such as the collection and
measurement of cardiorespiratory specimens, volumes, pressures, and
flows; ((and
(11)
The drawing and analyzing of)) (k) The insertion of
devices to draw, analyze, infuse, or monitor pressure in arterial,
capillary, ((and mixed)) or venous blood ((specimens)) as
((ordered)) prescribed by ((the attending)) a
physician or an advanced registered nurse practitioner as authorized by the
nursing care quality assurance commission under chapter 18.79 RCW; and
(l) Diagnostic monitoring of and therapeutic interventions for desaturation, ventilatory patterns, and related sleep abnormalities to aid the physician in diagnosis.
(2) Nothing in this chapter prohibits or restricts:
(a) 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, that may overlap the services provided by respiratory care practitioners;
(b) 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 rules of the United States;
(c) The practice of respiratory care by a person pursuing a supervised course of study leading to a degree or certificate in respiratory care as a part of an accredited and approved educational program, if the person is designated by a title that clearly indicates his or her status as a student or trainee and limited to the extent of demonstrated proficiency of completed curriculum, and under direct supervision;
(d) The use of the title "respiratory care practitioner" by registered nurses authorized under chapter 18.88 RCW; or
(e) The practice without compensation of respiratory care of a family member.
Nothing in this chapter shall be construed to require that individual or group policies or contracts of an insurance carrier, health care service contractor, or health maintenance organization provide benefits or coverage for services and supplies provided by a person licensed under this chapter.
Sec. 5. RCW 18.89.050 and 1994 sp.s. c 9 s 512 are each amended to read as follows:
(1) In addition to any other authority provided by law, the secretary may:
(a) Adopt rules, in accordance with chapter 34.05 RCW, necessary to implement this chapter;
(b)
Set all ((certification)) license, examination, and renewal fees
in accordance with RCW 43.70.250;
(c) Establish forms and procedures necessary to administer this chapter;
(d)
Issue a ((certificate)) license to any applicant who has met the
education, training, and examination requirements for ((certification)) licensure;
(e)
Hire clerical, administrative, and investigative staff as needed to implement
this chapter and hire individuals ((certified)) licensed under
this chapter to serve as examiners for any practical examinations;
(f)
Approve those schools from which graduation will be accepted as proof of an
applicant's eligibility to take the ((certification)) licensure
examination, specifically requiring that applicants must have completed
programs with two-year curriculum;
(g)
Prepare, grade, and administer, or determine the nature of, and supervise the
grading and administration of, examinations for applicants for ((certification))
licensure;
(h) 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;
(i)
Determine which states have legal credentialing requirements equivalent to
those of this state and issue ((certificates)) licenses to
individuals legally credentialed in those states without examination;
(j)
Define and approve any experience requirement for ((certification)) licensure;
and
(k) Appoint members of the profession to serve in an ad hoc advisory capacity to the secretary in carrying out this chapter. The members will serve for designated times and provide advice on matters specifically identified and requested by the secretary. The members shall be compensated in accordance with RCW 43.03.220 and reimbursed for travel expenses under RCW 43.03.040 and 43.03.060.
(2)
The provisions of chapter 18.130 RCW shall govern the issuance and denial of ((certificates,
uncertified)) licenses, unlicensed practice, and the disciplining of
persons ((certified)) licensed under this chapter. The secretary
shall be the disciplining authority under this chapter.
Sec. 6. RCW 18.89.060 and 1991 c 3 s 229 are each amended to read as follows:
The
secretary shall keep an official record of all proceedings, a part of which
record shall consist of a register of all applicants for ((certification))
licensure under this chapter, with the result of each application.
Sec. 7. RCW 18.89.080 and 1994 sp.s. c 9 s 513 are each amended to read as follows:
The
secretary, ad hoc committee members, or individuals acting on their behalf are
immune from suit in any civil action based on any ((certification)) licensure
or disciplinary proceedings, or other official acts performed in the course of
their duties.
Sec. 8. RCW 18.89.090 and 1991 c 3 s 232 are each amended to read as follows:
The
secretary shall issue a ((certificate)) license to any applicant
who demonstrates to the secretary's satisfaction that the following
requirements have been met:
(1) Graduation from a school approved by the secretary or successful completion of alternate training which meets the criteria established by the secretary;
(2) Successful completion of an examination administered or approved by the secretary;
(3) Successful completion of any experience requirement established by the secretary;
(4) Good moral character.
In
addition, applicants shall be subject to the grounds for denial or issuance of
a conditional ((certificate)) license under chapter 18.130 RCW.
A
person who meets the qualifications to be admitted to the examination for ((certification))
licensure as a respiratory care practitioner may practice as a
respiratory care practitioner under the supervision of a respiratory care
practitioner ((certified)) licensed under this chapter between
the date of filing an application for ((certification)) licensure
and the announcement of the results of the next succeeding examination for ((certification))
licensure if that person applies for and takes the first examination for
which he or she is eligible.
The secretary shall establish by rule what constitutes adequate proof of meeting the criteria.
Sec. 9. RCW 18.89.110 and 1996 c 191 s 76 are each amended to read as follows:
(1)
The date and location of the examination shall be established by the
secretary. Applicants who have been found by the secretary to meet the other
requirements for ((certification)) 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 secretary 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 shall meet
generally accepted standards of fairness and validity for ((certification))
licensure examinations.
(3) All examinations shall be conducted by the secretary, 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 compliance with administrative procedures, administrative requirements, and fees determined by the secretary under RCW 43.70.250 and 43.70.280 and such remedial education as is deemed necessary.
(5)
The secretary may approve an examination prepared and administered by a private
testing agency or association of credentialing boards for use by an applicant
in meeting the ((certification)) licensure requirement.
Sec. 10. RCW 18.89.120 and 1996 c 191 s 77 are each amended to read as follows:
Applications
for ((certification)) licensure shall be submitted on forms
provided by the secretary. The secretary may require any information and
documentation which reasonably relates to the need to determine whether the
applicant meets the criteria for ((certification)) licensure
provided in this chapter and chapter 18.130 RCW. All applicants shall comply
with administrative procedures, administrative requirements, and fees
determined by the secretary under RCW 43.70.250 and 43.70.280.
Sec. 11. RCW 18.89.140 and 1996 c 191 s 78 are each amended to read as follows:
((Certificates))
Licenses shall be renewed according to administrative procedures,
administrative requirements, continuing education requirements, and fees
determined by the secretary under RCW 43.70.250 and 43.70.280.
Sec. 12. RCW 18.120.020 and 1996 c 178 s 9 are each 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: Podiatric
medicine and surgery under chapter 18.22 RCW; chiropractic under chapter 18.25
RCW; dental hygiene under chapter 18.29 RCW; dentistry under chapter 18.32 RCW;
denturism under chapter 18.30 RCW; dispensing opticians under chapter 18.34
RCW; hearing ((aids)) instruments under chapter 18.35 RCW;
naturopaths under chapter 18.36A 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; 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 and 18.71A RCW; emergency medicine under
chapter 18.73 RCW; physical therapy under chapter 18.74 RCW; practical nurses
under chapter 18.79 RCW; psychologists under chapter 18.83 RCW; registered
nurses under chapter 18.79 RCW; occupational therapists licensed under chapter
18.59 RCW; respiratory care practitioners ((certified)) licensed
under chapter 18.89 RCW; veterinarians and animal technicians under chapter
18.92 RCW; health care assistants under chapter 18.135 RCW; massage
practitioners under chapter 18.108 RCW; acupuncturists licensed under chapter 18.06
RCW; persons registered or certified under chapter 18.19 RCW; dietitians and
nutritionists certified by chapter 18.138 RCW; radiologic technicians under
chapter 18.84 RCW; and nursing assistants registered or certified under chapter
18.88A 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. 13. RCW 18.130.040 and 1996 c 200 s 32 and 1996 c 81 s 5 are each reenacted and amended to read as follows:
(1) This chapter applies only to the secretary and the boards and commissions 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 secretary has authority under this chapter in relation to the following professions:
(i) Dispensing opticians licensed under chapter 18.34 RCW;
(ii) Naturopaths licensed under chapter 18.36A RCW;
(iii) Midwives licensed under chapter 18.50 RCW;
(iv) Ocularists licensed under chapter 18.55 RCW;
(v) Massage operators and businesses licensed under chapter 18.108 RCW;
(vi) Dental hygienists licensed under chapter 18.29 RCW;
(vii) Acupuncturists licensed under chapter 18.06 RCW;
(viii) Radiologic technologists certified and X-ray technicians registered under chapter 18.84 RCW;
(ix)
Respiratory care practitioners ((certified)) licensed under
chapter 18.89 RCW;
(x) Persons registered or certified under chapter 18.19 RCW;
(xi) Persons registered as nursing pool operators under chapter 18.52C RCW;
(xii) Nursing assistants registered or certified under chapter 18.79 RCW;
(xiii) Health care assistants certified under chapter 18.135 RCW;
(xiv) Dietitians and nutritionists certified under chapter 18.138 RCW;
(xv) Sex offender treatment providers certified under chapter 18.155 RCW;
(xvi) Persons licensed and certified under chapter 18.73 RCW or RCW 18.71.205;
(xvii) Persons registered as adult family home providers and resident managers under RCW 18.48.020; and
(xviii) Denturists licensed under chapter 18.30 RCW.
(b) The boards and commissions having authority under this chapter are as follows:
(i) The podiatric medical board as established in chapter 18.22 RCW;
(ii) The chiropractic quality assurance commission as established in chapter 18.25 RCW;
(iii) The dental quality assurance commission as established in chapter 18.32 RCW;
(iv) The board of hearing and speech as established in chapter 18.35 RCW;
(v) The board of examiners for nursing home administrators as established in chapter 18.52 RCW;
(vi) The optometry board as established in chapter 18.54 RCW governing licenses issued under chapter 18.53 RCW;
(vii) 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;
(viii) The board of pharmacy as established in chapter 18.64 RCW governing licenses issued under chapters 18.64 and 18.64A RCW;
(ix) The medical quality assurance commission as established in chapter 18.71 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 nursing care quality assurance commission as established in chapter 18.79 RCW governing licenses issued under that chapter;
(xiii) The examining board of psychology and its disciplinary committee as established in chapter 18.83 RCW; and
(xiv) The veterinary board of governors as established in chapter 18.92 RCW.
(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. This chapter also governs any investigation, hearing, or proceeding relating to denial of licensure or issuance of a license conditioned on the applicant's compliance with an order entered pursuant to RCW 18.130.160 by the disciplining authority.
(4) All disciplining authorities shall adopt procedures to ensure substantially consistent application of this chapter, the Uniform Disciplinary Act, among the disciplining authorities listed in subsection (2) of this section.
NEW SECTION. Sec. 14. The following acts or parts of acts are each repealed:
(1) RCW 18.89.130 and 1991 c 3 s 236 & 1987 c 415 s 14; and
(2) RCW 18.89.900 and 1987 c 415 s 20.
NEW SECTION. Sec. 15. This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect July 1, 1997.
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