SENATE PROPOSAL OF AMENDMENT
2004
H.609
Page 1
H.609
AN ACT RELATING TO THE LICENSURE OF RESPIRATORY CARE
PRACTITIONERS
The Senate proposes to the House to amend the bill as follows:
First: In Sec. 2, 26 V.S.A. § 4701, by striking out subdivisions (7), (8), and
(9) in their entirety and inserting in lieu thereof new subdivisions (7), (8), and
(9) to read as follows:
(7) “Performance of respiratory care” means respiratory care in
accordance with the prescription of a licensed physician, licensed osteopath,
certified physician assistant, certified anesthesiologist assistant, or licensed
nurse practitioner, including the diagnostic and therapeutic use of the
following:
(A) Medical gases (except for the purpose of anesthesia), aerosols,
and humidification.
(B) Pharmacologic agents.
(C) Mechanical or physiological ventilatory support.
(D) Bronchopulmonary hygiene.
(E) Cardiopulmonary resuscitation.
(F) Insertion and maintenance of artificial airways.
(G) Specific diagnostic and testing techniques employed in the
medical management of patients to assist in diagnosis, monitoring, treatment,
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SENATE PROPOSAL OF AMENDMENT
2004
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and research of pulmonary abnormalities, including measurements of
ventilatory volumes, pressures, and flows, collection and analysis of specimens
of blood and blood gases and specimens from the respiratory tract, expired and
inspired gas samples, respiratory secretions, and pulmonary function testing
and hemodynamic and other related physiologic measurements of the
cardiopulmonary system.
(H) Insertion and maintenance of arterial and venous catheters.
(8) “Practice of respiratory care” means:
(A) Direct and indirect respiratory care services, including the
administration of pharmacologic, diagnostic, and therapeutic agents necessary
to implement a treatment, disease prevention, pulmonary rehabilitative, or
diagnostic regimen by a licensed physician, physician assistant,
anesthesiologist assistant, or nurse practitioner.
(B) Transcription and implementation of written or verbal orders of a
licensed physician, physician assistant, anesthesiologist assistant, or nurse
practitioner which pertains to the practice of respiratory care.
(C) Observing and monitoring signs and symptoms, general behavior,
general physical response to respiratory care treatment and diagnostic testing,
including determination of whether such signs, symptoms, reactions, behavior,
or general response exhibits abnormal characteristics.
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SENATE PROPOSAL OF AMENDMENT
2004
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(D) Implementing report, referral, and respiratory care protocols or
changes in treatment, based on observed abnormalities, pursuant to a
physician, physician assistant, anesthesiologist assistant, or nurse practitioner’s
prescription.
(E) Initiating emergency procedures pursuant to rules adopted by the
director or as otherwise provided under this chapter.
(F) Respiratory care may be practiced in any clinic, hospital, skilled
nursing facility, private dwelling, or other place deemed appropriate or
necessary by the director and in accordance with the prescription or verbal
orders of a licensed physician, physician assistant, anesthesiologist assistant, or
nurse practitioner.
(9) “Respiratory care” means the allied health profession responsible for
the treatment, management, diagnostic testing, control, and care of patients
with deficiencies and abnormalities associated with cardiopulmonary systems
under the direction of a physician, physician assistant, anesthesiologist
assistant, or nurse practitioner. Respiratory care also includes inhalation
therapy and respiratory therapy.
Second: In Sec. 2, by striking out 26 V.S.A. § 4712 in its entirety and
inserting in lieu thereof a new 26 V.S.A. § 4712 to read as follows:
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SENATE PROPOSAL OF AMENDMENT
2004
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§ 4712. EXEMPTIONS FROM LICENSURE
(a) No person shall practice respiratory care or represent himself or herself
to be a respiratory care practitioner unless he or she is licensed under this
chapter, except that this chapter shall not prohibit:
(1) A person matriculated in an education program approved by the
board who is pursuing a degree in respiratory care or respiratory therapy from
satisfying supervised clinical education requirements related to the person’s
respiratory care education while under direct supervision of a respiratory care
practitioner or physician.
(2) A respiratory care practitioner from practicing in the United States
Armed Services, United States Public Health Services, or the Department of
Veterans’ Affairs, pursuant to federal regulations of health care providers.
(3) A respiratory care practitioner who is licensed in another jurisdiction
of the United States from providing consultation by telecommunications.
(4) A respiratory care practitioner who is licensed in another jurisdiction
of the United States or foreign educated respiratory care practitioner
credentialed in another country from practicing respiratory care in conjunction
with teaching or participating in an educational seminar of no more than 60
days in a calendar year.
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SENATE PROPOSAL OF AMENDMENT
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(5) Those individuals meeting the aide/assistant classification or those
working under medical supervision in a pulmonary function testing or research
facility.
(6) Respiratory care rendered in an emergency.
(7) Self care by a patient or gratuitous care by family members or
friends who do not represent themselves as respiratory care practitioners.
(8) A respiratory care practitioner who is licensed in another jurisdiction
of the United States or a foreign educated respiratory care practitioner
credentialed in another country from practicing respiratory care in conjunction
with the interfacility transport of a critically ill patient.
(9) A home care medical equipment dealer from performing services
related to delivery, setup, instruction, or maintenance of durable medical
equipment, including home respiratory equipment. This exemption does not
include therapeutic evaluation or assessment.
(10) An assistant or aide working under the direct or indirect supervision
of a supervisor of record. Practice under this exemption is limited in scope and
shall not include the exercising of independent clinical judgment. The
assistant or aide shall follow well-defined and supervised procedures for
nonacute patient care. The scope of practice shall be limited to equipment
processing, oxygen delivery setup and monitoring, pulse oximetry and shall be
preassessed by a supervisor of record. Treatments are limited to: small
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SENATE PROPOSAL OF AMENDMENT
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volume medication nebulizers, metered dose inhalers, chest physiology with or
without postural drainage, and incentive spirometry or peak flow monitoring.
(11) A polysomnographic technologist, technician, or trainee from
performing activities within the scope of practice adopted by the association of
polysomnographic technologists, while under the direction of a Vermont
licensed physician who has training in sleep medicine.
(12) A perfusionist from performing those activities contained within
the perfusion scope of practice adopted by the American Society of
Extracorporeal Technologists, or its successor organization, while under
the supervision of a licensed physician.
(b) This chapter does not restrict a person licensed or certified under any
other law of this state from engaging in the profession or practice for which
that person is licensed or certified if that person does not represent, imply, or
claim that he or she is a respiratory care practitioner or a provider of
respiratory care. This chapter does not expand the scope of practice of any
other profession or occupation referred to in this chapter.
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