Proponent Testimony on HB 266 by Sue Ciarlariello, Legislative Chair, Ohio Society for Respiratory Care before the
House Health and Aging Committee, October 14, 2015
Madame Chair and distinguished members of the Health and Aging Committee,
My name is Sue Ciarlariello and I am here today representing the Ohio Society for Respiratory Care (OSRC), the professional organization for Respiratory Care Professionals (RCP’s) licensed by the Ohio Respiratory Care Board. I currently serve the OSRC as its volunteer Legislative Chair. I have worked at Dayton Children’s Hospital as the Director of
Respiratory Care for 30 years and have also had the privilege of serving as a professional member of the Ohio
Respiratory Care Board (ORCB) from 1999-2011, appointed by both Governor Taft and Governor Strickland. My experience on the ORCB has given me the first-hand knowledge of why the proposed changes to the respiratory care law
(ORC. 4761), in HB 266 are necessary.
This bill has been drafted with input from the Ohio Respiratory Care Board and has been circulated to the Ohio
Pharmacy Board, Ohio Medical Board, Ohio Nursing Board, Ohio Hospital Association and a number of medical professional societies. There has been no opposition voiced to date.
The issues that HB 266 address fall under the following areas: Physician Assistant authority to prescribe respiratory care, licensing exams, student limited permit requirements, grounds for disciplinary action, and protocol based care.
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At the time HB 266 was drafted, Physician Assistants were not authorized to prescribe respiratory care and RCP’s were only authorized in ORC 4761 to accept orders from physicians and nurse-practitioners. We understand that this has recently been corrected in the passing of SB 110.
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The original respiratory care law implies that the ORCB will administer its own licensing exam. HB 266 recognizes that the ORCB uses a state or national exam for licensing that meets the standards defined in rules, rather than an exam administered by the ORCB. It also states that the ORCB shall not charge exam fees for exams administered by a state or national organization.
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Student limited permits require the student to be “in good standing” in their respiratory care program. Twenty three schools in Ohio each have their own definition of “in good standing.” HB 266 allows the ORCB to define what conditions must be met to be “in good standing” in a respiratory care program that allows a student to be eligible for a limited permit.
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Under grounds for disciplinary action 4761.09 , the current law includes : “Using any dangerous drug, as defined in section 4729.01
of the Revised Code, or alcohol to the extent that the use impairs the ability to practice respiratory care at an acceptable level of competency;” this has required the ORCB to prove that a therapist who is under the influence of drugs or alcohol is incompetent to practice, when in such a situation, the RCP would not be allowed to work to demonstrate their incompetence. HB 266 gives the ORCB authority to impose disciplinary action on a licensee who is practicing or being present with an intent to practice respiratory care while showing signs of impairment from being under the influence of any dangerous drug or alcohol. It also adds two definitions of impairment from the Ohio Nursing Board Law: o Self- administering or otherwise taking into the body any dangerous drug in any way that is not in accordance with a legal, valid prescription issued for that individual, or self-administering or otherwise taking into the body any drug that is a schedule I controlled substance.

o Habitual or excessive use of controlled substances, alcohol, or other habit-forming drugs or chemical substances to the extent that the use impairs the individual’s ability to provide safe respiratory care.
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Currently, the ORCB does not have authority to impose continued sanctions from other licensed states for respiratory therapists who transfer to Ohio. HB 266 allows the ORCB to impose continued disciplinary action on licensees from other states for any reason other than failure to renew.
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Respiratory protocols are used to adapt care to a patient’s given condition to assure that the right care is delivered at the right time. Many publications, most notably, those from the Cleveland Clinic Foundation, authored by Dr. Jamie Stoller, demonstrated that medically approved respiratory protocols reduced unnecessary care by 40% and improved outcomes in their facility. In the State of Ohio, the pharmacy board defines medical protocols: pre-hospital, biologics, and inpatient. The ORCB worked with the Ohio Board of Pharmacy in 2005 on the language for medical protocols for inpatients. RCP’s work under the rules of the OBP when administering medications. However, respiratory care protocols, extend beyond medical protocols. As a director, my staff at
DCH work under protocols for the management of patients with asthma, bronchiolitis and post-trauma atelectasis. Medical staff approved respiratory protocols include preventive measures for reducing ventilator associated pneumonias or unplanned extubations, protocols for ventilator set-up and weaning, assessment of extubation readiness, advancing bronchial hygiene therapies, etc. These are protocols for therapies, not medications. HB 266 adds a definition of Respiratory Care protocols as a set of treatment or medication guidelines for Respiratory Care Professional (RCP) practice and gives the Ohio Respiratory Care Board (ORCB) authority to define standards for protocols to be developed in rules. It also adds to RCP’s practice requirement, a medically approved protocol for respiratory care.
Madame Chair and distinguished committee, thank you for this opportunity to comment today. I would be happy to answer any questions at this time or by email or phone in the future.
Sue Ciarlariello MBA RRT-NPS RCP
Director, Respiratory Care
Dayton Children’s Hospital ciarlariellos@childrensdayton.org
937-641-3388