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 new sections to
chapter 18.89 RCW; repealing RCW 18.89.130 and 18.89.900; providing effective
dates; 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. 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, as determined by
the secretary, 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 18.79 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:
(1)
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)))
(a) Graduation from a school approved by the secretary or successful
completion of alternate training which meets the criteria established by the
secretary;
(((2)))
(b) Successful completion of an examination administered or approved by
the secretary;
(((3)))
(c) Successful completion of any experience requirement established by
the secretary;
(((4)))
(d) 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.
(2)
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.
(3)
A person certified as a respiratory care practitioner in good standing on the
effective date of this act, who applies within one year of the effective date
of this act, may be licensed without having completed the two-year curriculum
set forth in RCW 18.89.050(1)(f), and without having to retake an examination
under subsection (1)(b) of this section.
(4)
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.
NEW
SECTION. Sec. 12. A
new section is added to chapter 18.89 RCW to read as follows:
An
applicant holding a license in another state may be licensed to practice in this
state without examination if the secretary determines that the other state's
licensing standards are substantially equivalent to the standards in this
state.
Sec.
13. 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.
14. 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. 15. 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. 16. (1) Sections
5, 9, and 10 of this act are necessary for the immediate preservation of the
public peace, health, or safety, or support of the state government and its
existing public institutions, and take effect July 1, 1997.
(2)
Sections 1 through 4, 6 through 8, and 11 through 15 of this act take effect
July 1, 1998.
