Report Title:

Respiratory Care Practitioners; Licensing



Establishes requirements for the regulation of respiratory care practitioners.



H.B. NO.














relating to health care.





     SECTION 1.  The legislature finds that the practice of respiratory care should be regulated to protect the public from unqualified practitioners 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 protect the public health, safety, and welfare, by regulating the practice 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, unless the context otherwise requires:

     "Board" means the Hawaii board for 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 respiratory care practitioners.

     "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 incorporates pre-clinical didactic and laboratory activities, and clinical activities; provided that the education is approved by an accrediting agency recognized by the board and includes an evaluation of competence through a standardized testing mechanism determined by the board to be valid and reliable.

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

     "Practice of respiratory care" means the assessment, diagnosis, intervention, and monitoring for patients requiring emergent and nonemergent respiratory interventions.  The term includes:

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

     (2)  The initiation of emergency procedures and protocols under the regulations of the board 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, or 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, and general physical response to respiratory care treatment and diagnostic testing, including determinations of whether such signs, symptoms, behaviors, or responses exhibit abnormal characteristics; and

     (7)  The implementation, based on observed abnormalities, of appropriate reporting, referral, or respiratory care protocols or changes in treatment pursuant to the written, verbal, or telecommunicated orders of a person licensed to practice medicine under the laws of the State.

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

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

     "Respiratory care practitioner" means a person who is:

     (1)  Duly licensed by the board;

     (2)  Employed in the practice of respiratory care and who has the knowledge and skill necessary to administer the practice of respiratory care or respiratory care services;

     (3)  Capable of serving as a resource to the physician and other healthcare providers in relation to the clinical and technical aspects of respiratory care and as to the safe and effective methods for administering respiratory care modalities;

     (4)  Able to function in situations of unsupervised patient contact requiring great individual judgment; and

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

     "Respiratory care services" includes the following activities performed under physician supervision or under the order of a licensed 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 authorized by 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 apparatuses, environmental control systems, humidification, and aerosols;

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

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

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

     (9)  Disease management services, procedures, and consulting, including those relating to asthma, chronic obstructive pulmonary disease, and smoking cessation;

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

    (11)  Invasive procedures, such as intravascular catheterization, specimen collection and analysis, blood for gas transport, acid/base determinations and indicators for metabolic processes and sputum for diagnostic purposes;

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

    (13)  Hyperbaric oxygen therapy;

    (14)  Noninvasive metabolic monitoring;

    (15)  Capnography and hemodynamic monitoring and interpretation;

    (16)  Sleep diagnostic studies; and

    (17)  Air or ground ambulance transport.

     "Special training" means a deliberate, systematic, educational activity in the affective, psychomotor, and cognitive domains, intended to develop new proficiencies with an application in mind and presented with an attention to needs, objectives, activities, and a defined means of evaluation.

     §    -2  Hawaii board for respiratory care.  (a)  There is established within the department of commerce and consumer affairs for administrative purposes the Hawaii board for respiratory care to administer the provisions of this chapter.  The board shall consist of the following seven members who shall all be citizens of the United States and residents of this state:

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

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

     (3)  A member of the general public; and

     (4)  One at-large member selected from among, but not limited to:

         (A)  Hospital representatives; and

         (B)  Representatives of the home health care industry.

     (b)  The terms of office of board members shall be as determined by the board.

     §    -3  Board operating procedures.  (a)  The board shall elect a chairperson and vice chairperson from the members described in section    -2(a)(1) and (2). 

     (b)  The board shall meet at least annually and may convene at the request of the chairperson, or as determined by the board.

     (c)  A majority of all members to which the board is entitled shall constitute a quorum to do business, and any action taken by the board shall be approved by a simple majority vote of the quorum.

     (d)  The board may appoint and employ a qualified person, who shall not be a member of the board, to serve as the administrative secretary to the board, and whose duties shall be defined by the board.

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

     §    -4  Board powers and responsibilities.  The board shall:

     (1)  Determine the qualifications and fitness of applicants for licensure, license renewals, 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 discipline persons licensed under this chapter and to enforce this chapter;

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

     (7)  Adopt any rules necessary to conduct the board's business, carry out board duties, and administer this chapter;

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

     (9)  Enter into agreements or contracts, consistent with state law, with other organizations for the purpose of developing, administering, grading, or reporting the results of licensure examinations.  Such organizations 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

    (10)  Establish continuing education requirements for license renewals.

     §    -5  Requirements for licensure.  (a)  Upon payment of a fee, an applicant for a license to practice respiratory care shall submit to the board written evidence, verified by oath, that the applicant:

     (1)  Is eighteen years of age;

     (2)  Has completed an approved four-year high school course of study or the equivalent thereof as determined by the appropriate educational agency;

     (3)  Has successfully completed an accredited respiratory care education program;

     (4)  Has passed an examination administered by the State or by a national agency approved by the board;

     (5)  Has paid the required fees; and

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

     (b)  If an applicant fails to complete the requirements for licensure within     days from the date of filing, the application shall be deemed abandoned.

     (c)  The board shall issue 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 in this state; or

     (2)  Applicants holding credentials, conferred by the National Board for Respiratory Care or its successor organization, as a certified respiratory therapist and/or as a registered respiratory therapist; provided that such credentials have not been suspended or revoked.

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

     §    -6  Professional identification.  (a)  A person who does not hold a license as a respiratory care practitioner or whose license has been suspended or revoked shall not engage in 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 use the designations "R.C.P.," "R.R.T.," or "L.R.T."; or use any other words, letters, abbreviations, or insignia indicating or implying that the person is a respiratory care practitioner; and

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

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

     §    -7  Renewal of license.  (a)  A license shall be renewed except as hereafter provided.  The board shall mail notices of renewal at least      calendar days prior to expiration of the license of 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 the notice to the board with the renewal fee before the date the license expires.

     (b)  Upon receipt of the notice of renewal and the fee, the board shall verify the contents of the notice and shall issue the licensee a license for the current renewal period, which shall be valid for the period stated thereon. 

     (c)  The board shall establish continuing education requirements for biennial renewal of the license.

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

     (e)  A respiratory care practitioner 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 as the practitioner remains inactive.  A practitioner seeking to resume the practice of respiratory care shall notify the board of the practitioner's intent and shall satisfy the requirements of this chapter, in addition to remitting the current renewal fee and the reinstatement fee.

     §    -8  Fees and disposition of revenue.  (a)  All fees, including application fees, licensing fees, renewal fees, and reinstatement fees shall be established by rules adopted by the board.

     (b)  Fees received by the board and monies collected under this chapter shall be deposited into the general fund.

     §    -9  Disciplinary criteria.  (a)  The board may revoke, suspend, or refuse to renew any license, or place on probation or otherwise reprimand a licensee or temporary licensee holder, or deny a license to an applicant if it finds that the person:

     (1)  Committed 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 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)  Has committed 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 violating any provision of this chapter; or

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

     §    -10  Complaints; board investigations.  (a)  Upon the filing of a written complaint with the board, charging a person with any of the acts described in section    -9, 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 thereto. The notice shall be by personal service or by certified or registered mail sent to the last known address of the person who is the subject of the complaint.

     (b)  The board may petition the circuit court to issue subpoenas for the attendance of witnesses and the production of necessary evidence in any hearing before the board.  Upon request of the respondent or his counsel, the board shall petition the court to issue subpoenas on behalf of the respondent.  The court upon petition may issue such subpoenas as it deems necessary.

     (c)  Unless otherwise provided in this chapter, hearing procedures shall be established by rules adopted by the board.  A person aggrieved by a decision of the board may file an appeal for judicial review pursuant to chapter 91.

     §    -11  Exceptions.  (a)  No person shall practice respiratory care or represent oneself to be a respiratory care practitioner unless the person is licensed under this chapter, except as otherwise provided by this chapter.

     (b)  This chapter shall 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 himself 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, and monitoring of medical devices, gases, and equipment and the maintenance thereof by a non-licensed person for the express purpose of self-care by a patient or gratuitous care by a friend or family member, where any patient monitoring, assessment, or other procedures designed to evaluate the effectiveness of prescribed respiratory care are 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 approved by the board.

     (c)  Nothing in this chapter is intended to limit, preclude, or otherwise interfere with the practice of other persons licensed by appropriate agencies of the State from performing a respiratory care procedure that is within the scope of practice of the licensee.

     (d)  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 such procedures for which the individual has been tested; provided that the testing body offering the examination is approved by the board.

     §    -12  Practice of medicine prohibited.  Nothing in this chapter shall be construed to permit the practice of medicine.

     §    -13  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 therein;

     (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 the provisions of this chapter;

     (4)  Impersonate in any manner or pretend to be a "respiratory care professional," "respiratory therapist," "respiratory care practitioner," "certified respiratory care practitioner," "licensed respiratory therapist," or "respiratory therapy technician"; or use the designation "R.C.P.," "R.R.T." or "L.R.T."; or use any other words, letters, abbreviations, or insignia indicating or implying that the person is a respiratory care practitioner, unless duly authorized by license to practice under the provisions of this chapter;

     (5)  Practice respiratory care while 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 currently held license required to practice respiratory care in this or any other jurisdiction;

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

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

     (9)  Otherwise violate any provision of this chapter.

     §    -14  Severability.  If any provision of this chapter or the application thereof to any person or circumstance is held invalid, the invalidity shall not affect other provisions or applications of this chapter that can be given effect without the invalid provision or application, and to this end the provisions of this chapter are severable."

     SECTION 3.  This Act shall take effect upon its approval.