Following the veto of California Senate Bill 1526, a letter was issued by the California Sleep Society (CSS) informing sleep professionals in the state that some of their sleep labs could be cited for thousands of dollars or face other disciplinary actions for allowing RPSGTs to perform respiratory care as it relates to polysomnography.

Signed into law in 1983, the Respiratory Care Practice Act tasks the Respiratory Care Board with overseeing the licensure and regulation of respiratory professionals.

“Respiratory diagnostic testing for obstructive sleep apnea and treatment via therapeutic interventions requiring positive airway pressure must be performed by a licensed respiratory care practitioner pursuant to the Respiratory Care Practice Act. To avoid legal penalties and/or discipline, it is imperative that each organization begin making the necessary changes, as applicable, immediately,” says the RCB.

The RCB had limited its regulation of respiratory care as it applies to polysomnography while SB 1526 was pending. However, the RCB is now cracking down on sleep labs that allow RPSGTs to perform functions reserved for respiratory professionals under the Respiratory Care Practice Act. “Citations may be issued to both unlicensed personnel and employers of unlicensed personnel illegally practicing respiratory care, with fine amounts up to $15,000,” according to Breathing Matters, an RCB newsletter.

“Throughout the Board’s review of this emerging practice and more recently this legislative process, pending the outcome of this bill, the Board limited its enforcement activity against the unlicensed practice of respiratory care as it relates to polysomnography. However, in light of the Governor’s veto, the Board has no reasonable alternative but to begin fully enforcing existing law,” says the Respiratory Care Board (RCB).

According to the CSS, “A number of sleep labs in the state have already received a letter from the Respiratory Care Board stating that the RCB has ‘received information’ that these labs are ‘using unlicensed personnel to perform functions that require a respiratory care practitioner license.”

The letter issued by the CSS also states that at least two sleep centers have been forced to hire RTs and an RN to supervise their RPSGTs following a State Department of Public Health inspection. However, the RCB says it was not involved with those incidents.

“Our board has not been involved with any recent actions taken by the California Department of Public Health,” says Stephanie Nunez, executive officer of the Respiratory Care Board of California.

The following tasks commonly associated with polysomnography are considered respiratory care by the RCB and must be performed by a respiratory therapist and not an RPSGT:

* The diagnostic and therapeutic use of oxygen.
* Noninvasive ventilatory assistance of spontaneously breathing patients and cardiopulmonary resuscitation.
* Establishment of baseline oxyhemoglobin saturation.
* Routine fitting of positive airway pressure mask or cannula.
* Maintenance of nasal and oral airways that do not extend into the trachea.
* Continuous observation, analysis, and recording of carbon dioxide concentrations in respiratory gases, and other respiratory events.
* Validation of respiratory-related data integrity
* Calibration of respiratory care devices
*  Implementing appropriate interventions, including actions necessary for patient safety.
* Applying the knowledge and skills necessary to recognize and provide age-specific respiratory care in the treatment, assessment, and education of neonatal, pediatric, adolescent, adult, and geriatric patients.
“Effective immediately, the Board will revitalize its investigations and enforcement of the unlicensed practice of respiratory care as it relates to polysomnography as identified above,” says the RCB. “The Board understands that major personnel shifts will need to occur for many, though not all, sleep testing organizations. Employers using RPSGT credentialed personnel may consider shifting their duties to focus directly on all sleep diagnostic testing and treatment (as applicable) that are not associated with respiratory care.”

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