Report Title:

Establish Board of Respiratory Care; Regulation of Respiratory Care



Establishes licensing and regulatory requirements for practice of respiratory care.  Establishes board of respiratory care in the department of commerce and consumer affairs, provides for disciplinary criteria, and penalties.



H.B. NO.














relating to respiratory care.





     SECTION 1.  The legislature finds and declares that the practice of respiratory care in the State affects the public health, safety, and welfare, and should be subject to regulation to protect the public from the unqualified practice of respiratory care and from unprofessional conduct by persons licensed to practice respiratory care.  The legislature also recognizes the practice of respiratory care to be a dynamic and changing art and science, the practice of which continues to evolve with more sophisticated techniques and clinical modalities in patient care.

     The purpose of this Act is to regulate the practice of respiratory care and to create a board of respiratory care.

     SECTION 2.  The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:



     §   ‑1  Definitions.  As used in this chapter:

     "Board" means the board of respiratory care.

     "Continuing education" means educational activities primarily designed to keep respiratory care practitioners informed of developments in the respiratory care field or any special areas of practice engaged in by these persons.

     "Direct supervision" means a situation where a licensed respiratory care practitioner or physician is immediately available for the purpose of communication, consultation, and assistance.

     "Formal education" means a supervised, structured, educational activity that:

     (1)  Includes preclinical didactic and laboratory activities and clinical activities;

     (2)  Is approved by an accrediting agency recognized by the board; and

     (3)  Includes an evaluation of competence through a standardized testing mechanism determined by the board to be both valid and reliable.

     "Physician supervision" means oversight under the authority and responsibility of a licensed physician to direct the performance of activities as established by policies, procedures, and protocols for safe and appropriate delivery of services.

     "Practice of respiratory care" means a collection of activities including assessment, diagnosis, intervention, and monitoring for patients requiring emergent and nonemergent respiratory intervention, including disaster preparedness and support, but is not limited to:

     (1)  Emergency actions to correct life-threatening respiratory events for patients of all ages;

     (2)  The initiation of emergency procedures and protocols under the board rules or as otherwise permitted in this chapter;

     (3)  The initiation and management of life-support ventilator equipment;

     (4)  The administration of pharmacological, diagnostic, and therapeutic agents related to respiratory care procedures necessary to implement a treatment, disease prevention, pulmonary rehabilitative, or diagnostic regimen prescribed by a physician;

     (5)  The transcription and implementation of the written, verbal, or telecommunicated orders of a physician pertaining to the practice of respiratory care;

     (6)  The observation and monitoring of signs and symptoms, general behavior, general physical response to respiratory care treatment, and diagnostic testing, including determination of whether the signs, symptoms, reactions, behavior, or general response exhibit abnormal characteristics;

     (7)  The implementation, based on observed abnormalities, appropriate reporting or referral of respiratory care protocols, or changes in treatment pursuant to the written, verbal, or telecommunicated orders by a physician; and

     (8)  The practice of respiratory care performed in any clinic, hospital, skilled nursing facility, private dwelling, or other place deemed appropriate or necessary by the board in accordance with the written, verbal, or telecommunicated order of a physician, and performed under physician supervision or orders.

     "Protocol" means a written agreement of medical care plan delegating professional responsibilities to a person who is qualified by training, competency, experience, or licensure.

     "Respiratory care education program" means a program of respiratory care education that is accredited by the Committee on Accreditation for Respiratory Care, or their successor organizations.

     "Respiratory care practitioner" means:

     (1)  A person duly licensed by the board;

     (2)  A person employed in the practice of respiratory care who has the knowledge and skill necessary to administer respiratory care;

     (3)  A person who is capable of serving as a resource to the physician and other health care providers in relation to the clinical and technical aspects of respiratory care and as to safe and effective methods for administering respiratory care modalities;

     (4)  A person who is able to function in situations of unsupervised patient contact requiring great individual judgment; and

     (5)  A person capable of supervising, directing, or teaching less skilled personnel in the provision of respiratory therapy services.

     "Respiratory care services" include but are not limited to the following activities performed under physician supervision or under the order of a physician, and in accordance with protocols established by a hospital or the board:

     (1)  Assistance with cardiopulmonary resuscitation;

     (2)  Ventilatory support, including the maintenance and management of life-support systems;

     (3)  Administration of medications to the cardiopulmonary system;

     (4)  With specialized training acceptable to the board, administration of medications by routes other than the respiratory route under the direct supervision of a physician;

     (5)  Therapeutic and diagnostic use of pressurized medical gases and administration apparatus, and environmental control systems, humidification and aerosols;

     (6)  Use of therapeutic modalities to augment secretion management, lung inflation, bronchopulmonary drainage, and monitor breathing exercises;

     (7)  Respiratory rehabilitation, pulmonary disease education, and prevention;

     (8)  Maintenance of natural airways, including the insertion and maintenance of artificial airways;

     (9)  Disease management services, procedures, and consulting, including but not limited to asthma, chronic obstructive pulmonary disease, and smoking cessation;

    (10)  Assistance with bronchoscopy procedures for diagnostic and therapeutic purposes;

    (11)  Invasive procedures, such as:

         (A)  Intravascular catheterization;

         (B)  Specimen collection and analysis;

         (C)  Blood for gas transport and acid base determinations and indicators for metabolic processes; and

         (D)  Sputum for diagnostic purposes;

    (12)  Pulmonary function testing and other related physiological monitoring of the cardiopulmonary systems;

    (13)  Hyperbaric oxygen therapy;

    (14)  Non-invasive metabolic monitoring;

    (15)  Capnography and hemodynamic monitoring and interpretation;

    (16)  Sleep diagnostic studies; and

    (17)  Air or ground ambulance transport.

     "Special training" means:

     (1)  A deliberate systematic educational activity in the affective, psychomotor, and cognitive domains;

     (2)  Is intended to develop new proficiencies with an application in mind; and

     (3)  Is presented with an attention to needs, objectives, activities, and a defined means of evaluation.

     §   ‑2  Board of respiratory care.  (a)  There is created the board of respiratory care to administer this chapter.  The board shall be attached to the department of commerce and consumer affairs for administrative purposes.  The board shall consist of seven members to be appointed by the governor pursuant to section 26‑34 and whose terms shall be four years; provided that the governor may reduce the terms of those initially appointed so as to provide, as nearly as can be, for the expiration of an equal number of terms at intervals of one year for each board:

     (1)  One public member;

     (2)  One physician member recommended by the Hawaii Society for Respiratory Care;

     (3)  Four members engaged in the practice of respiratory care for a period of not less than one year immediately preceding appointment and recommended by the state affiliate of the American Association for Respiratory Care; and

     (4)  One member who is a representative of a hospital or the home health care industry.

     (b)  The board shall meet at least once each year and shall elect a chairperson and vice chairperson from its physician member and from its respiratory care practitioner members.  The board may convene at the request of the chairperson, or as determined by the board.  A majority of the members of the board, including the chairperson or vice-chairperson, shall constitute a quorum at any meeting and a majority of the required quorum shall be sufficient for the board to take action by vote.

     (c)  Members shall serve without compensation but shall be reimbursed for expenses, including travel expenses, necessary for the performance of their duties.

     (d)  Members shall have the same rights of protection from personal liability as those enjoyed by other employees of the State for actions taken in the course of their duties under this chapter.

     (e)  The board may hire a qualified person without regard to chapters 76 and 89 who shall not be a member of the board to serve as administrative secretary, and shall define the duties of the administrative secretary, in addition to those enumerated in this chapter.

     §   ‑3  Powers and duties of board.  The board shall:

     (1)  Determine the qualifications and fitness of applicants for licensure, renewal of license temporary licenses, and reciprocal licenses to practice respiratory care;

     (2)  Examine, approve, issue, deny, revoke, suspend, and renew the licenses of duly qualified applicants to practice respiratory care;

     (3)  Establish standards of professional responsibility and practice for persons licensed by the board;

     (4)  Keep a record of all proceedings of the board, which shall be made available to the public for inspection during reasonable business hours;

     (5)  Conduct investigations, subpoena individuals, and records, and do all things necessary and proper to:

         (A)  Discipline persons licensed under this chapter;

         (B)  Enforce this chapter; and

         (C)  Conduct hearings upon charges calling for discipline of a licensee, denial, revocation, or suspension of a license;

     (6)  Adopt rules in accordance with chapter 91 necessary to carry out this chapter;

     (7)  Maintain a public record of persons licensed by the board;

     (8)  Enter into agreements or contracts, in accordance with law, with outside entities for the purpose of developing, administering, grading, and reporting the results of licensure examinations.  These entities shall be capable of meeting the standards of the National Commission for Health Certifying Agencies or its equivalent or successor organization.  The licensure examinations shall be validated and nationally recognized as testing respiratory care competencies; and

     (9)  Establish continuing education requirements for renewal of a license.

     §   ‑4  License; requirements.  (a)  No person shall practice respiratory care or represent oneself to be a respiratory care practitioner unless the person is licensed under this chapter.

     (b)  An applicant for a license to practice respiratory care shall submit to the board written evidence, verified by oath, that the applicant:

     (1)  Is at least eighteen years of age;

     (2)  Has completed an approved four-year high school course of study, or the equivalent, as determined by the board of education;

     (3)  Has successfully completed an accredited respiratory care educational program as defined in this chapter;

     (4)  Has passed an examination, as defined in this chapter, which may be administered by the board or by a national agency approved by the board;

     (5)  Has paid the required fees; and

     (6)  Meets any other requirements established by the board.

     (c)  The board shall issue a license to an applicant who has successfully met the requirements in subsection (b).  If an applicant fails to complete the requirements for licensure within       days from the date of filing, the application shall be deemed to be abandoned.

     (d)  The board shall issue to the applicant a license to practice respiratory care by endorsement to:

     (1)  An applicant who is currently licensed or registered to practice respiratory care under the laws of another state, territory, or country if the qualifications of the applicant are deemed by the board to be equivalent to those required by this chapter; or

     (2)  An applicant holding credentials conferred by the National Board for Respiratory Care or its successor organization as a certified respiratory therapist or as a registered respiratory therapist; providing the credential has not been suspended or revoked.

     (e)  A license issued under this chapter shall be subject to biennial renewal.

     §   ‑5  Professional identification.  (a)  No person who does not hold a license as a respiratory care practitioner or whose license has been suspended or revoked may do any of the following:

     (1)  Use in connection with the person's practice the words "respiratory care professional", "respiratory therapist", "respiratory care practitioner", "certified respiratory care practitioner", "licensed respiratory therapist" or "respiratory therapy technician"; or append the letters "R.C.P.", "R.R.T." or "L.R.T." to one's name; or use any other words, letters, abbreviations, or insignia indicating or implying that the person is a respiratory care practitioner; or

     (2)  Directly, or by implication, represent in any way that the person is a respiratory care practitioner.

     (b)  A licensee shall show the person's license when requested.

     §   ‑6  License renewal.  (a)  A license shall be renewed except as hereafter provided.  The board shall mail notices at least        calendar days prior to expiration for renewal of licenses to every person to whom a license was issued or renewed during the preceding renewal period.  The licensee shall complete the notice of renewal and return it to the board with the renewal fee before the date of expiration.

     (b)  Upon receipt of the notice of renewal and the fee, the board shall verify its contents and shall issue the licensee a license for the renewal period.  The board shall establish continuing education requirements for biennial renewal of the license.

     (c)  A licensee who allows a license to lapse by failing to renew may be reinstated by the board upon payment of the renewal fee and a reinstatement fee; provided that a request for reinstatement is made within         days of the end of the renewal period.

     (d)  A licensee who does not engage in the practice of respiratory care during the succeeding renewal period is not required to pay the renewal fee as long that person remains inactive.  If the person desires to resume the practice of respiratory care, the person shall notify the board of the person's intent, and shall demonstrate compliance with the specific period of time of continuous inactivity after which re-testing is required, in addition to remitting the current renewal fee and the reinstatement fee.

     §   ‑7  Fees and disposition of revenues.  (a)  The board shall adopt rules in accordance with chapter 91 to establish all fees, including but not limited to application fees, licensing fees, renewal fees, and reinstatement fees.

     (b)  Fees collected by the board and moneys collected under this chapter shall be deposited into the state treasury to the credit of the state general fund.

     (c)  Expenses incurred in the implementation of this chapter shall be paid within the appropriations made by the legislature.

     §   ‑8  Disciplinary criteria.  The board may revoke, suspend, or refuse to renew any license, place on probation, otherwise reprimand a licensee or temporary license holder, or deny a license to an applicant if the board finds that the person:

     (1)  Is guilty of fraud or deceit in procuring or attempting to procure a license or renewal of a license to practice respiratory care;

     (2)  Is unfit or incompetent by reason of negligence, habits, or other causes of incompetence;

     (3)  Is habitually intemperate in the use of alcoholic beverages;

     (4)  Is addicted to, or has improperly obtained, possessed, used, or distributed habit-forming drugs or narcotics;

     (5)  Is guilty of dishonest or unethical conduct;

     (6)  Has practiced respiratory care after the person's license has expired or has been suspended;

     (7)  Has practiced respiratory care under cover of any license illegally or fraudulently obtained or issued;

     (8)  Has violated or aided or abetted others in violation of this chapter; or

     (9)  Has been convicted of a felony that materially affects the person's ability to safely practice respiratory care.

     §   ‑9  Due process.  (a)  Upon filing of a written complaint with the board charging a person with any of the acts described in section    ‑8, the administrative secretary or other authorized employee of the board shall make an investigation.  If the board finds reasonable grounds for the complaint, a time and place for a hearing shall be set, notice of which shall be served on the licensee or applicant at least        calendar days prior to the hearing.  The notice shall be made by personal service or by certified mail sent to the last known address of the person.

     (b)  The board may petition the circuit court of the county within which the hearing is being held to issue subpoenas for the attendance of witnesses and the production of necessary evidence in any hearing before it.  Upon request of the respondent or the respondent's counsel, the board shall petition the court to issue subpoenas on behalf of the respondent.  The circuit court, upon petition, may issue any subpoenas that the court deems necessary.

     (c)  Unless otherwise provided in this chapter, hearing procedures shall be held in accordance with chapter 92.  A person who is aggrieved by a decision of the board may file an appeal.

     §   ‑10  Exceptions.  (a)  This chapter does not prohibit:

     (1)  The practice of respiratory care that is an integral part of the program of study by students enrolled in an accredited respiratory care education program approved by the board.  Students enrolled in respiratory care education programs shall be identified as "student RT" and shall only provide respiratory care under the direct supervision of an appropriate clinical instructor recognized by the education program;

     (2)  Self-care by a patient or gratuitous care by a friend or family member who does not represent or hold the person out to be a respiratory care practitioner;

     (3)  Respiratory care services rendered in the course of an emergency;

     (4)  Respiratory care administered in the course of assigned duties of persons in the military services;

     (5)  The delivery, set-up, monitoring, and maintenance of medical devices, gases, and equipment by an unlicensed person for the express purpose of self-care by a patient or gratuitous care by a friend or family member.  Any patient monitoring, assessment, or other procedures designed to evaluate the effectiveness of prescribed respiratory care shall be performed by or pursuant to the delegation of a licensed respiratory care practitioner; or

     (6)  The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or special training acceptable to the board.

     (b)  Nothing in this chapter is intended to limit, preclude, or otherwise interfere with the practice of other appropriately licensed persons from performing a respiratory care procedure that is within the scope of practice of that person.

     (c)  Individuals who have passed an examination that includes content in one or more of the functions included in this section shall not be prohibited from performing those procedures for which the individual has been tested; provided that the testing body offering the examination is approved by the board.

     §   ‑11  Practice of medicine prohibited.  Nothing in this chapter shall be construed to permit the practice of medicine.

     §   ‑12  Offenses.  (a)  It is a misdemeanor for any person to:

     (1)  Sell, fraudulently obtain or furnish any respiratory care license or record, or aid or abet in doing so;

     (2)  Practice respiratory care under cover of any respiratory care diploma, license, or record illegally or fraudulently obtained or issued;

     (3)  Practice respiratory care unless duly licensed to do so under this chapter;

     (4)  Improperly identify oneself in violation of section    ‑5(a)(1);

     (5)  Practice respiratory care when the person's license is suspended, revoked, or expired;

     (6)  Fail to notify the board of the suspension, probation, or revocation of any past or current license required to practice respiratory care in this State or any other state;

     (7)  Knowingly employ an unlicensed person in the capacity of a respiratory care practitioner;

     (8)  Make false representations, impersonate, or act as a proxy for another individual or allow or aid any individual to impersonate the person in connection with any examination, application for licensing, or request to be examined or licensed; and

     (9)  Otherwise violate any provision of this chapter.

     (b)  A misdemeanor shall be punishable by a fine of not more than $        or by imprisonment of not more than         , or by both fine and imprisonment for each offense."

     SECTION 3.  If any provision of this Act, or the application thereof to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of the Act, which can be given effect without the invalid provision or application, and to this end the provisions of this Act are severable.

     SECTION 4.  This Act shall take effect upon its approval.