Agenda Item 30

tiiTATiil Ofl CALifiOAN I A

Board of Vocational Nursing and Psychiatric Technicians 2535 Capitol Oaks Drive Suite 205 Sacramento CA 95833-2945 Clc a Phone 9 16-263-7800 Fax 916-263-7855 wwwbvnpt ca gov

DEPARTMENT OF CONS UMER AHAIRS

DATE January 27 20 17

TO Board Members

FROM Kameka Brown PhD MBA NP Executive Officer

SUBJECT Report of the Legislative and Regulations Committee

Attached for review is the January 5 2017 Report of the Legislative and Regulations Comm ittee

Agenda Item 30

BOARD OF VOCATIONAL NURSING amp PSYCHIATRIC TECHNICIANS o ca 2535 Capitol Oaks Drive Suite 205 Sacramento CA 95833-2945 DEPARTMENT OF CONS UMER AFFAIRS Phone (9 16) 263-7800 Fax (916) 263-7855 Web wwwbvnptcagov

LEGISLATION AND REGULATIONS COMMITTEE MEETING MINUTES

January 5 2017

SACRAMENTO CALIFORNIA

BOARD MEMBERS PRESENT Todd DBraunstein PT Member

John Dierking Public Member

STAFF PRESENT Dr Kameka Brown Executive Officer Cheryl Anderson Acting Assistant Executive Officer Samantha Calma Acting Associate Governmental Program Analyst Tim Matsumoto Associate Governmental Program Analyst - Retired Annuitant

1 CALL TO ORDER

The meeting was called to order by Chairperson John Dierking at 100 pm

2 INTRODUCTION OF COMMITTEE MEMBERS AND BOARD STAFF

Committee Members introduced themselves Dr Kameka Brown Executive Officer introduced Board staff present

3 DISCUSSION AND POSSIBLE ACTION ON THE LEGISLATION AND REGULATION COMMITTEE SCOPE

A copy of the Role of the Legislative and Regulations Committee was provided to the Committee Chairs and Board Staff present to review and discuss possible revisions

Board Discussion bull Both Mr Dierking and Mr DBraunstein had no revisions to the current Role of the Legislative

and Regulations Committee document

Motion To recommend the Board adopt the Role of the Legislative and Regulations Committee at the February 2017 Board Meeting

Moved Todd DBraunstein Seconded John Dierking

4 STAFFING UPDATES

Dr Brown provided an update on the vacant Legislation and Regulations Analyst position within the Board She reported that Board staff conducted two rounds of hiring interviews however no qualified candidate was selected Due to the existing need to fill this position the position was advertised internally as a 120-day out of class assignment (OOC) and was filled with an existing Board staff member The Board is currently recruiting to fill the position permanently

Committee Discussion None

Motion No motion required

5 DISCUSSION AND CONSIDERATION OF IMPACT OF BUSINESS AND PROFESSIONS CODE DIVISION 2 CHAPTER 83 ARTICLE 6 ON SCOPE OF PRACTICE OF LICENSED VOCATIONAL NURSES AND PSYCHIATRIC TECHNICIANS

Dr Brown discussed the information provided in the Scope of Practice Comparison document as it relates to respiratory care She stated the Respiratory Care Boards (RCB) concern is that the Board is expanding its scope of practice Dr Brown clarified that the Board will maintain its current scope of practice She added that schools are teaching ventilator management and our current scope is to practice basic assessment

Committee Discussion bull Ms Anderson agreed that basic assessment is in the current scope of practice She stated that

the RCB has reached out to the Board in an effort to discuss this issue with the Committee bull Dr Brown asked if VNs should perform this scope of work and recommended regulations be

updated

Motion No motion required

6 DISCUSSION AND POSSIBLE ACTION ON SUNSET QUESTION REGARDING MERGING BVNPT WITH OTHER OCCUPATIONAL LICENSING BOARD OR CONTINUED EXISTENCE AS A SEPARATE BOARD

Mr DBraunstein talked about the BVNPT merge with other occupational Boards and expressed concern with this question on the Boards Biennial Sunset Report He also discussed an email dated January 5 2017 that he and Dr Brown received from Coby Pizzotti Consultant with the California Association of Psychiatric Technicians (CAPT) to Sarah Huchel Senate Business and Professions Committee In the email Mr Pizzotti indicates he spoke to Ms Huchel regarding the potential merge and expressed CAPTs concerns regarding the BRNs ability to handle an increase in workload Mr Pizzotti also expressed concern regarding CAPTs issues being overshadowed by the BRN

Committee Discussion

2

bull Dr Brown stated the Boards Sunset Hearing has not been scheduled as of yet and that there would be two separate hearings She stated that Assembly Business and Professions made this concern a Sunset question Dr Brown discussed her conversation with BRN Board President Michael Jackson and the BRN Executive Officer Joseph Morris stating that they do not want to move forward as an umbrella board

bull Mr Dierking expressed concern why merging of the boards is not a good idea and that the BRN has a different scope of practice

bull Dr Brown commented that merging of the Boards would put the California Psychiatric Technician profession at risk

bull Mr Dierking indicated that he would reach out to other Department of Consumer Affairs (DCA) occupational licensing BoardsBureaus in Southern California to obtain their perspective and position on this issue

bull Dr Brown commented that no further action was required on this agenda item and that Board staff would continue to monitor the issue

Motion No motion required

7 DISCUSSION CONSIDERATION AND COMMITTEE RECOMMENDATIONS RELATED TO BILLS OF INTEREST

Dr Brown informed the Committee Chairs that a copy of the current bills and Legislative and Regulations Committee recommendations will be included in the February 2017 Board Meeting materials to the Board Members

Committee Discussion bull Mr DBraunstein commented that he spoke to a Little Hoover Commission Representative and

that there is no proposed legislation on this issue as of yet bull Dr Brown recommended the Committee provide a response to Board staff regarding Bills of

Interest by Friday January 27 2017 She added that January 20 2017 is the final day to submit bill requests to the Office of Legislative Counsel

bull Both Mr DBraunstein and Mr Dierking agreed to respond to Board staff by the January 27 2017 due date

Motion No motion required

8 ADJOURNMENT

The meeting was adjourned at 215pm

Attachments Attachment A Role of the Legislative and Regulations Committee Attachment B Scope of Practice Comparison BampP Code Attachment C BampP Code Division 2 Chapter 83 Article 6

3

Agenda Item 31Attachment A II T ATii 0~ CA L I~ O RN I A

CIC a DEP ARTMENT OF CONSUMER AFFAIRS

- middot- -~

BOARD OF VOCATIONAL NURSING amp PSYCHIATRIC TECHNICIANS 2535 Capito l Oaks Drive Suite 205 Sacramento CA 95833-294 5 Phone (9 16) 263-7800 Fax (916) 263-7855 Web wwwbvnotcagov

Role of the Legislative and Regulations Committee

The Legislative and Regulations Committee (Committee) of the Board of Vocational Nursing and Psychiatric Technician (Board) is comprised of two (2) members that are appointed by the Board President

The Committee is charged with the research and analysis of proposed legislation and regulations that impact the Board s mission and the healthcare of California Consumers Such legislation and regulations may include but are not limited to the following areas

)gt The role of the Board in ensuring the development of a safe and competent healthcare workforce

)gt The education and licensure of Licensed Vocational Nurses and Psychiatric Technicians

)gt The utilization and practice of Licensed Vocational Nurses and Psychiatric Technicians

The Committee is also authorized to solicit input from stakeholders

After the completion of relevant research and analysis the Committee is authorized to recommend to the Board a position of Support Oppose or Watch The Committee is also authorized by the Board to act on legislation and regulations between scheduled Board meetings Such action(s) must be reported to and ratified by the full Board at the next scheduled Board meeting

If the proposed legislation or regulation is progressing expeditiously through the committees of the Legislature or regulatory process the Executive Officer or designee shall consult with Committee Members to obtain direction and implement a position That direction may include but is not limited to the following

)gt Formulation and submission of letters of support or opposition

)gt Provision of testimony at hearings

)gt Discussions with Legislators and or their staff

This allows a timely response to newly introduced or amended legislative middotproposals Such action will then be ratified by the full Board at its next scheduled meeting

bull Dr Brown stated the Boards Sunset Hearing has not been scheduled as of yet and that there would be two separate hearings She stated that Assembly Business and Professions made this concern a Sunset question Dr Brown discussed her conversation with BRN Board President Michael Jackson and the BRN Executive Officer Joseph Morris stating that they do not want to move forward as an umbrella board

bull Mr Dierking expressed concern why merging of the boards is not a good idea and that the BRN has a different scope of practice

bull Dr Brown commented that merging of the Boards would put the California Psychiatric Technician profession at risk

bull Mr Dierking indicated that he would reach out to other Department of Consumer Affairs (DCA) occupational licensing BoardsBureaus in Southern California to obtain their perspective and position on this issue

bull Dr Brown commented that no further action was required on this agenda item and that Board staff would continue to monitor the issue

Motion No motion required

7 DISCUSSION CONSIDERATION AND COMMITTEE RECOMMENDATIONS RELATED TO BILLS OF INTEREST

Dr Brown informed the Committee Chairs that a copy of the current bills and Legislative and Regulations Committee recommendations will be included in the February 2017 Board Meeting materials to the Board Members

Committee Discussion bull Mr DBraunstein commented that he spoke to a Little Hoover Commission Representative and

that there is no proposed legislation on this issue as of yet bull Dr Brown recommended the Committee provide a response to Board staff regarding Bills of

Interest by Friday January 27 2017 She added that January 20 2017 is the final day to submit bill requests to the Office of Legislative Counsel

bull Both Mr DBraunstein and Mr Dierking agreed to respond to Board staff by the January 27 2017 due date

Motion No motion required

8 ADJOURNMENT

The meeting was adjourned at 215pm

Attachments Attachment A Role of the Legislative and Regulations Committee Attachment B Scope of Practice Comparison BampP Code Attachment C BampP Code Division 2 Chapter 83 Article 6

3

Agenda Item 31Attachment A II T ATii 0~ CA L I~ O RN I A

CIC a DEP ARTMENT OF CONSUMER AFFAIRS

- middot- -~

BOARD OF VOCATIONAL NURSING amp PSYCHIATRIC TECHNICIANS 2535 Capito l Oaks Drive Suite 205 Sacramento CA 95833-294 5 Phone (9 16) 263-7800 Fax (916) 263-7855 Web wwwbvnotcagov

Role of the Legislative and Regulations Committee

The Legislative and Regulations Committee (Committee) of the Board of Vocational Nursing and Psychiatric Technician (Board) is comprised of two (2) members that are appointed by the Board President

The Committee is charged with the research and analysis of proposed legislation and regulations that impact the Board s mission and the healthcare of California Consumers Such legislation and regulations may include but are not limited to the following areas

)gt The role of the Board in ensuring the development of a safe and competent healthcare workforce

)gt The education and licensure of Licensed Vocational Nurses and Psychiatric Technicians

)gt The utilization and practice of Licensed Vocational Nurses and Psychiatric Technicians

The Committee is also authorized to solicit input from stakeholders

After the completion of relevant research and analysis the Committee is authorized to recommend to the Board a position of Support Oppose or Watch The Committee is also authorized by the Board to act on legislation and regulations between scheduled Board meetings Such action(s) must be reported to and ratified by the full Board at the next scheduled Board meeting

If the proposed legislation or regulation is progressing expeditiously through the committees of the Legislature or regulatory process the Executive Officer or designee shall consult with Committee Members to obtain direction and implement a position That direction may include but is not limited to the following

)gt Formulation and submission of letters of support or opposition

)gt Provision of testimony at hearings

)gt Discussions with Legislators and or their staff

This allows a timely response to newly introduced or amended legislative middotproposals Such action will then be ratified by the full Board at its next scheduled meeting

Agenda Item 31Attachment A II T ATii 0~ CA L I~ O RN I A

CIC a DEP ARTMENT OF CONSUMER AFFAIRS

- middot- -~

BOARD OF VOCATIONAL NURSING amp PSYCHIATRIC TECHNICIANS 2535 Capito l Oaks Drive Suite 205 Sacramento CA 95833-294 5 Phone (9 16) 263-7800 Fax (916) 263-7855 Web wwwbvnotcagov

Role of the Legislative and Regulations Committee

The Legislative and Regulations Committee (Committee) of the Board of Vocational Nursing and Psychiatric Technician (Board) is comprised of two (2) members that are appointed by the Board President

The Committee is charged with the research and analysis of proposed legislation and regulations that impact the Board s mission and the healthcare of California Consumers Such legislation and regulations may include but are not limited to the following areas

)gt The role of the Board in ensuring the development of a safe and competent healthcare workforce

)gt The education and licensure of Licensed Vocational Nurses and Psychiatric Technicians

)gt The utilization and practice of Licensed Vocational Nurses and Psychiatric Technicians

The Committee is also authorized to solicit input from stakeholders

After the completion of relevant research and analysis the Committee is authorized to recommend to the Board a position of Support Oppose or Watch The Committee is also authorized by the Board to act on legislation and regulations between scheduled Board meetings Such action(s) must be reported to and ratified by the full Board at the next scheduled Board meeting

If the proposed legislation or regulation is progressing expeditiously through the committees of the Legislature or regulatory process the Executive Officer or designee shall consult with Committee Members to obtain direction and implement a position That direction may include but is not limited to the following

)gt Formulation and submission of letters of support or opposition

)gt Provision of testimony at hearings

)gt Discussions with Legislators and or their staff

This allows a timely response to newly introduced or amended legislative middotproposals Such action will then be ratified by the full Board at its next scheduled meeting

Agenda Item 30Attachment B SCOPE OF PRACTICE COMPARISON

California West Virginia Louisiana 2859 Practice of Voc Nursing The practice of vocational nursing within the meaning of this chapter is the performance of services requiring those technical manual skills acqui red by means of a course in an approved school of vocational nursing or its equiva lent practiced under the direction of a licensed physician or registered professional nurse

The LPN can practice under the direction of a registered professional nurse lice nsed physician or licensed dentist

The practice of practical nursing is defined in Section 961 of Chapter 11 Louisiana Revised Statutes of 1950 Accord ing to this law practical nursing is the performance for pay of acts in the care trea tm ent or observation of th e ill and for the maintenance of the health of others and the promotion of health ca re Practical nurses may train and or supervise other nurses and subordinate personnel They may also instruc t patients A licensed practical nurse must practice under the direction of one of the following licensed physician optometrist dentist psychologist or registered nurse A licensed practical nurse may perform duties consistent with hi sher educational preparation The licensed practical nurse may also with appropriate training (which is approved by this board and documented) perform additional specified acts which are authorized by the Lou isiana State Board of Practical Nurse Exam iners when directed to do so by the licensed physician optometrist dentist psychologist or registered nurse

11 P a ge 012017

The licensed practical nurse Practice The licensed vocational nurse performs services requ iring technical and manual skills which include the following (a) Uses and practices basic assessment (data collection) participates in planning executes interventions in accordance with the care plan or treatment plan and contributes to evaluation of individualized interventions related to the care plan or treatment plan

practicing under the direction of a registered professional nurse licensed physician or licensed dentist shall 31 contribute to the nursing assessment by collecting reporting and recording objective and subjective data in an accurate and timely manner Data collection includes but is not limited to observations of 31a the condition or change in the co ndition of a client and 31b signs and symptoms of deviation from normal health status 32 participate in the development of the strategy of care in consultation with other nursing personnel Participation in the development of a strategy of care includes 32a contributing to the identification of priorities 32b contributing to setting realistic and measurable goals and 32c contributing to the selection of nursing interventions which include measures to maintain comfort support human functions and responses maintain an environment conducive to wellshybeing and provide health teach and counse

Practical Nurse Examiners (LS BPNE) has no laundry list of tasksskills an lpn can perform Such lists tend to limit practice Scope of practice is a fluid concept It changes as knowledge and technology expand Lpns must possess the knowledge skill and ability to perform their duties therefore scope of practice comes down to the competency of the individuallpn

21 Page 012017

2518 5 (b) Scope ofVN Provide nursing care under the Practice direction of a registered Provides direct patientclient professional nurse by care by which the licensee 33a caring for cl ients whose (1) Performs basic nursing cond itions are stabilized or services as defined in predictable subdivision (a)[seen above 33b assisting with clients (2) Administers medications whose conditions are criti cal (3) Applies communication skills andor fluctuating under the for the purpose of patientclient direct supervision of the care and education and registered professiona l nurse (4) Contributes to the 33c implem enting nursing care development and according to the priority of implementation of a teaching needs and established plan related to self-care for the practices patientclient 33d providing an environment

conducive to safety and health 3 3e documenting nursing interventions and responses to care and 33f communicating nursing interven tions and responses to care to appropriate members of the health team 34 Assign components of nursing care to other qualified persons and 35 Contribute to the evaluation of the responses of individuals and groups to nursing interventions by 35a monitoring the responses to nursing interventions 35b documenting and communicating assessment data to appropriate members of the health care team and 35c contributing to the modification of the strategy of care on the basis of the assessment data

3I P age 012017

10-3-4 Standard s Relating to the Licens ed Practi cal Nurses Responsibil ities as a Member of the Healt h Care Team The Licensed Practica l Nurse shall 4 1 be familiar with the statutes and rules governing nursing 42 clearly display on his or her name tag or other identification badge their licensing credential (LPN) 43 function within the legal boundaries of practica l nursing practice 44 accept responsibility for individual nursing actions competencies and behavior 45 function under the direction of a registered professional nurse licensed physician or licensed dentist 46 consult with the registered professional nurse to seek guidance in delivery of nursing care as necessary 47 obta in instru ction and supervision as necessa ry from the registered professional nurse when implementing nursing techniques or practices 48 retain accountability for the timely and accurate completion of tasks assigned to other qualified persons 49 function as a member of the health team 41 0 contribute to the formulation interpretation implementation and evaluation of the objectives and po licies related to practical nursing pra ctice within the employment setting 411 participate in the evaluation of nursing through peer review 4 12 report unsafe nursing practice to the Board and unsafe practice conditions to recognized legal authorities 413 conduct practice w ithout discrimination on the basis of age race religion sex sexual preference nationa l origin or hand

41 Page 012017

A enda Item 30 Att achment B~~ 414 respect the dignity and rights of clients regardless of social or economic status personal attributes or the nature of the health problem 415 respect the clients right to privacy by protecting confidential information unless obligated by law to disclose the information 416 respect the property of employers clients and their families and 417 participate in relevant continuing competence activities to maintain current knowledge and skill levels in practical nursing as required in West Virginia State Board of Examiners for Licensed Practical Nurses Rule Continuing Competence 10 CSR6

SIPage 012017

L VNs must be Board-certified (post-licensure certification) in IV Therapy

25421 Intravenous Therapy No laws exist and IV Therapy is Initiate and maintain IV therapy The Board will consider a not part of basic PN Program and administer IV medications licensed vocational nurse as IV Therapy is not prohibited if by IVPB andor IVP (including competent to start and LPN has been trained and is hyperalimentation blood and superimpose intravenous fluids adequately supervised blood products) via primary or secondary infusion lines who has completed one of the following (a) A course in intravenous therapy approved by the Board as defined in Section 25423 (b) Submitted certification satisfactory to the Board by one of the persons specified in Section 25424 that the licensee has been instructed in the subject areas specified in Section 25423 and that the licensee has the knowledge skills and abilities to safely practice venipuncture For further limitations see Business and Professions Code section 28605

2542 Definition As used in this Article (a) Intravenous fluids means fluid solutions of electrolytes nutrients vitamins blood and blood products (b) Superimpose means to connect a container of intravenous fluid to tubing through which another container of intravenous fluid has just been administered (c) Primary infusion line means the line which provides a direct infusion between the container and the peripheral vein (d) Secondary infusion line means a line which provides infusion through a lateral access into a primary infusion line

61 P age 012017

enda Item 30Attachment B

May reinsert suprap ubic catheters in well-healed tract

May accept verbalphone orders No law - LPN s must follow from licensed physician or policies of employing facili ty registered nurse May only impl ement those orders that are within the LVN scope of

012017

arinization during

LVN who is Board-Certif ied in IV Therapy ca n maintain heparin lock using sa line or hepari n but cannot administer medications or solutions other than flu id solutions of electrolytes nutrients vitamins blood and blood Cannot perform Pap

SmearsGC cultures or check strin gs for IUD Ca n check fetal heart tones but ca n on ly count cannot assess Cannot perform

olds Maneuvers Can apply Unna Boots

Can loadmonitor PCA pumps administering subcutaneous medication Cannot load PCA pumps administering intravenous medication Can monitor pump and report status toRN when pump is adminis IV medication If LVN is Boa rd-certified in IV and Blood Withdrawa l the LVN ca n

bull Obtain blood specimens bull Connect and monitor flu id

solutions of electrolytes nutrients vitamins blood and blood products

bull Cannot connect IVPB unless it con tains flu id solutions of electrolytes nutrients vitamins blood and blood produ cts

bull Can provide site ca re includi

Can ca re for clien ts with internal venous access devices

dressi cha

Reinsertion of suprapubic catheters

Accept verbalphone orders directly from the prescriber (an optometrist advanced practice registered nurse physician dentist or psychologist)

Maintain and administer meds via heparin locks

Pap smearsGC cu lturesI UD string checksfund al heart tonesLeopolds m aneuvers

Apply Unn a Boots

Loadmonitor PCA machines

Care for clients with external venous ca theters (includ in g Hickman Groshong Brovia) and specifica lly obtain blood specimensconnect and monitor IV fluids connect IVPB provide site care (including dressi ng cha nges)

71 Pa ge

Care for clients with internal venous access devices

(including port-a-cath life port) and specifically access with andor remove Huber needledraw bloodconnect and monitor IV fluids (fluid solutions of electrolytes nutrients vitamins blood and blood products) and provide site care (includinq dressinq chanqes) Can perform head to toe physical examinations

A~g enda Item 30 Att h ac ment B (including port-a-cath life port) and specifically access with andor remove Huber needledraw bloodconnect and monitor IV fluids and provide site care (including dressing changes)

Perform head to toe physical assessments

Can reinsert tracheostomy tube in a well-healed tract

Reinsert a tracheostomy tube in an established tract

Can insert feeding tube in a neonate

Insert a feeding tube in a neonate

Remove sheaths in a cardiac cath lab and later dc these lines

An LVN can administer in-line nebulized medication If the ventilator breathing circuit is manipulated simply to establish a port for the medication such manipulation may be done by the LVN If the manipulation in any way changes the parameters of the ventilator delivery the LVN cannot perform such actions

Perform tasks which promote pulmonary health and hygiene (administer oxygen aerosol and IPPB treatments suction perform CPT etc) LPNS MAY NOT HOLD THEMSELVES OUT AS RESPIRATORY THERAPISTS OR RESPIRATORY THERAPY TECHNICIANS

The LVN may change the inner cannula of a tracheostomy during trach care and may disconnect the circuit to do so

The LVN cannot titrate oxygen liter flow to effect The L VN may adjust the flow in accordance with a specific order from the physician

In all cases the LVN must possess the knowledge skill and ability to perform the procedures safely and competently

8IPage 012017

Agenda Item 30Attachment C middot

BUSINESS AND PROFESSIONS CODE - BPC DIVISION 2 HEALING ARTS [500- 4999129]

(Division 2 enacted by Slats 1937 Ch 399) CHAPTER 83 Respiratory Therapy [3700 bull 3779] (Chapter 83 added by Stats 1982 Ch 1344 Sec 1)

ARTICLE 6 Offenses and Enforcement [3760- 37693] (Article 6 added by Stats 1982 Ch I 344 Sec 1 )

3760

(a) Except as otherwise provided in this chapter no person shall engage In the practice of respiratory care respiratory therapy or Inhalation therapy For purposes of this section engaging In the practice of respiratory care Includes but Is not limited to representations by a person whether through verbal claim sign advertisement letterhead business card or other representation that he or she is able to perform any respiratory care service or performance of any respiratory care service

(b) No person who Is unlicensed or whose respiratory care practitioner license has been revoked or suspended or whose license is not valid shall engage in the practice of respiratory care during the period of suspension or revocation even though the person may continue to hold a certificate or registration issued by a private certifying entity

(c) Except as otherwise provided in this chapter no person may represent himself or herself to be a respiratory care practitioner a respiratory therapist a respiratory care technician or an Inhalation therapist or use the abbreviation or letters RCP RP RT or IT or use any modifications or derivatives of those abbreviations or letters without a current and valid license issued under this chapter

(d) No respiratory care practitioner applicant shall begin practice as a respiratorymiddot care practitioner applicant pursLiant to Section 3739 until the applicant meets the applicable requirements of this chapter and obtains a valid work permit

(Amended by Stats 2003 Ch 586 Sec 14 Effective Jan(lary 1 2004)

(a) No person may practice respiratory care or represent himself or herself to be a middotmiddot -~-------resprratolV care prattltloTer-nnnls staremiddot withOm-a-validllcense grarttedlJtder~middot

this chapter except as otherwise provided in this chapter

(b) No person or corporation shall knowingly employ a person who holds himself or herself out to be a respiratory care practitioner without a valid license granted under this chapter except as otherwise provided In this chapter

(Amended by Stats 2003 Ch 586 Sec 15 Effective Jan(lary 1 2004)

1

Notlling in this chapter is Intended to limit preclude or otherwise Interfere with the practices of other llcensed personnel in carrying out authorized and customary duties and functions (Amended by Stats 1994 Ch 1274 Sec 25 Effective January 1 1995)

Jlli

Any person who violates any of the provisions of this chapter shall be guilty of a misdemeanor punisllable by a fine not exceeding one tllousanq dollars ($1000) or Imprisonment In a county jail not exceeding six months or both for each offense (Amended by Stats 1994 Ch 1274 Sec 26 Effective January 1 1995) middot

3764

Whenever any person has engaged or Is about to engage In any acts or practices that constitute or will constitute an offense against tills chapter the superior court of any county on application of the board the Medical Board of Callfornla or by 10 or more persons holding respiratory care practitioner licenses Issued under this chspter msy Issue sn injunction or other appropriate order restrslnlng that conduct Proceedings under this section sllall be governed by Chapter 3 (commencing with Section 525) of Title 7 of Part 2 of the Code of Civil ProcedLire except that no undertaking shall be required in any action commenced by the board (Amended by Stats 1995 Ch 279 Sec 23 Effective January 1 1996)

3765

This act does not prohibit any of the following activities

(a) The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs

(b) Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold himseff or herself out to be a respiratory care practitioner licensed under the provisions of this chapter

(c) The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or specialized training bull

(d) The psufiumancl oLrllipjritory_car~jJJ_an emetgellcY slt~IltJlQDJlYParamegical - _I personnel who have been formally tniined in these modalities and are duly licensed under the provisions of an act pertaining to their specialty

(e) Respiratory care services in case of an emergency Emermiddotgency as used In this subdivision Includes an epidemic or public disaster

(f) Persons from engaging in cardiopulmonary research

2

(g) Formally trained licensees and staff of child day care facilities from administering to a child Inhaled medication as defined in Section 1596798 of the Health and Safety Code

(h) The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the State Department of Public Health of specific limited and basic respiratory care or respiratory care related services that have been authorized by the board

(i) The performance of pulmonary function testing by persons who are currently employed by Los Angeles County hospitals and have performed pulmonary fLinctlon testing for at least 15 years

middot(Amended by Stats 2013 Ch 516 Sec 23 Effective January 1 2014)

(a) The board may issue a citation containing an order of abatement and civil penalties against a person who acts In the capacity of or engages In the business of a respiratory care practitioner In this state without having a license in good standing Issued pursuant to this chapter

(b) The board may Issue a citation containing an order of abatement and civil penalties against a person employing or contracting with a person who acts In the capacity of or engages In the business of a respiratory care practitioner in this state without having a license In good standing issued pursuant to this chapter

(Added by Stats 2002 Ch 1150 Sec 34 Effective January 1 2003)

(a) The board shall issue a citation to a person and to his or her employer or contractor if upon Inspection or Investigation either upon complaint or otherwise the following conditions are met (1) The board has probable cause to believe that the person is acting in

the capacity of or engaging In the practice of a respiratory care practitioner In this state without having a license in good standing issued pursuant to this chapter

(2) The person Is not otherwise exempted from the provisions of this chapter

(b) Each citation Issued pursuant to subdivision (a) shall meet all of the following -middot---middot--middot-----reqUirem-ents- middot - middot -- -middotmiddotmiddotmiddot--middot---middot-----middot--middotmiddot middot-middot middot middotmiddot- middot middot-middot ---middot--middotmiddot

(1) Be In writing and describe with particuladty the basis of the citation (2) Contain an order of abatement and an assessment of a civil penalty in

an amount not less than two hundred dollars ($200) nor more than fifteen thousand dollars ($15000)

(c) A person served with a citation may appeal to the board within 15 calendar clays after service of the citation with respect to any of the following (1) Tile violations alleged

3

(2) The scope of the order of abatement (3) The amount of the civil penalty assessed

(d) middot middot If within 15 calendar days after service of the citation the person cited falls to notify the board that he or she Intends to appeal the citation the citation shall be deemed a final order of the board and not subject to review by any court or agency The board may extend the 15-day period for good cause

(e) (1) If a person cited under this section notifies the board In a timely manner that he or she Intends to contest the citation the board shall afford an opportunity for a hearing

(2) The board shall thereaftEr issue a decision based on findings of fact affirming modifying or vacating the citation or directing other appropriate relief

(f) With the approval of the board the executive officer shall prescribe procedures for the issuance and appeal of a citation and procedures for a hearing under this section The board shall adopt regulations covering the assessment of a civil penalty that shall give due consideration to the gravity of the violation and any history of previous violations

(g) middotThe sanctions authorized under this section sl1all be separate from and In addition to any other civil or criminal remedies

(Added by Stats 2002 Ch 1150 Sec 35 Effective Jan11ary 1 2003)

(a) After the exhaustion of the review procedures provided for In Section 3767 and as adopted by regulation the board may apply to the appropriate superior court for both of the following (1) A judgment In the amount of the civil penalty (2) An order compelling the cited person to comply with the order of

abatement

(b) The application described In subdivision (a) shall include a certified copy of the final order of the board

(c) The application described In subdivision (a) shall constitute a sufficient showing to warrant the issuance of the judgment and ordermiddot

middotmiddotmiddot middot middot middotmiddot middotmiddot middot middot middot middot (ar--IITe-lloard may-employcollectlon-agenclesuruther methods-in-ordermiddotto-collect-- middot middot civil penalties

(Added by Stats 2002 Ch 1150 Sec 36 Effective January 1 2003)

37693

4

0 I

(a) Notwithstanding any other provision the board may by stipulation with the affected licensee issue a middotpublic reprimand after it has conducted an Investigation In lieu of filing or prosecuting a formal accusation

(b) The stipulation shall contain the authority grounds and causes and circumstances for taking such action and by way of waiving the affected licensees rights Inform the licensee of his or her rights to have a formal accusation filed and stipulate to a settlement thereafter or have the matter in the statement of Issues heard before an administrative law judge In accordance wltli the Administrative Procedure Act (Chapter 35 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code)

(c) The stipulation shall be public Information and shall be used as evidence in any future disciplinary or penalty action taken by the board

(Amended by Stats 2011 Ch 296 Sec 5 Effective January 1 2012)

5

The licensed practical nurse Practice The licensed vocational nurse performs services requ iring technical and manual skills which include the following (a) Uses and practices basic assessment (data collection) participates in planning executes interventions in accordance with the care plan or treatment plan and contributes to evaluation of individualized interventions related to the care plan or treatment plan

practicing under the direction of a registered professional nurse licensed physician or licensed dentist shall 31 contribute to the nursing assessment by collecting reporting and recording objective and subjective data in an accurate and timely manner Data collection includes but is not limited to observations of 31a the condition or change in the co ndition of a client and 31b signs and symptoms of deviation from normal health status 32 participate in the development of the strategy of care in consultation with other nursing personnel Participation in the development of a strategy of care includes 32a contributing to the identification of priorities 32b contributing to setting realistic and measurable goals and 32c contributing to the selection of nursing interventions which include measures to maintain comfort support human functions and responses maintain an environment conducive to wellshybeing and provide health teach and counse

Practical Nurse Examiners (LS BPNE) has no laundry list of tasksskills an lpn can perform Such lists tend to limit practice Scope of practice is a fluid concept It changes as knowledge and technology expand Lpns must possess the knowledge skill and ability to perform their duties therefore scope of practice comes down to the competency of the individuallpn

21 Page 012017

2518 5 (b) Scope ofVN Provide nursing care under the Practice direction of a registered Provides direct patientclient professional nurse by care by which the licensee 33a caring for cl ients whose (1) Performs basic nursing cond itions are stabilized or services as defined in predictable subdivision (a)[seen above 33b assisting with clients (2) Administers medications whose conditions are criti cal (3) Applies communication skills andor fluctuating under the for the purpose of patientclient direct supervision of the care and education and registered professiona l nurse (4) Contributes to the 33c implem enting nursing care development and according to the priority of implementation of a teaching needs and established plan related to self-care for the practices patientclient 33d providing an environment

conducive to safety and health 3 3e documenting nursing interventions and responses to care and 33f communicating nursing interven tions and responses to care to appropriate members of the health team 34 Assign components of nursing care to other qualified persons and 35 Contribute to the evaluation of the responses of individuals and groups to nursing interventions by 35a monitoring the responses to nursing interventions 35b documenting and communicating assessment data to appropriate members of the health care team and 35c contributing to the modification of the strategy of care on the basis of the assessment data

3I P age 012017

10-3-4 Standard s Relating to the Licens ed Practi cal Nurses Responsibil ities as a Member of the Healt h Care Team The Licensed Practica l Nurse shall 4 1 be familiar with the statutes and rules governing nursing 42 clearly display on his or her name tag or other identification badge their licensing credential (LPN) 43 function within the legal boundaries of practica l nursing practice 44 accept responsibility for individual nursing actions competencies and behavior 45 function under the direction of a registered professional nurse licensed physician or licensed dentist 46 consult with the registered professional nurse to seek guidance in delivery of nursing care as necessary 47 obta in instru ction and supervision as necessa ry from the registered professional nurse when implementing nursing techniques or practices 48 retain accountability for the timely and accurate completion of tasks assigned to other qualified persons 49 function as a member of the health team 41 0 contribute to the formulation interpretation implementation and evaluation of the objectives and po licies related to practical nursing pra ctice within the employment setting 411 participate in the evaluation of nursing through peer review 4 12 report unsafe nursing practice to the Board and unsafe practice conditions to recognized legal authorities 413 conduct practice w ithout discrimination on the basis of age race religion sex sexual preference nationa l origin or hand

41 Page 012017

A enda Item 30 Att achment B~~ 414 respect the dignity and rights of clients regardless of social or economic status personal attributes or the nature of the health problem 415 respect the clients right to privacy by protecting confidential information unless obligated by law to disclose the information 416 respect the property of employers clients and their families and 417 participate in relevant continuing competence activities to maintain current knowledge and skill levels in practical nursing as required in West Virginia State Board of Examiners for Licensed Practical Nurses Rule Continuing Competence 10 CSR6

SIPage 012017

L VNs must be Board-certified (post-licensure certification) in IV Therapy

25421 Intravenous Therapy No laws exist and IV Therapy is Initiate and maintain IV therapy The Board will consider a not part of basic PN Program and administer IV medications licensed vocational nurse as IV Therapy is not prohibited if by IVPB andor IVP (including competent to start and LPN has been trained and is hyperalimentation blood and superimpose intravenous fluids adequately supervised blood products) via primary or secondary infusion lines who has completed one of the following (a) A course in intravenous therapy approved by the Board as defined in Section 25423 (b) Submitted certification satisfactory to the Board by one of the persons specified in Section 25424 that the licensee has been instructed in the subject areas specified in Section 25423 and that the licensee has the knowledge skills and abilities to safely practice venipuncture For further limitations see Business and Professions Code section 28605

2542 Definition As used in this Article (a) Intravenous fluids means fluid solutions of electrolytes nutrients vitamins blood and blood products (b) Superimpose means to connect a container of intravenous fluid to tubing through which another container of intravenous fluid has just been administered (c) Primary infusion line means the line which provides a direct infusion between the container and the peripheral vein (d) Secondary infusion line means a line which provides infusion through a lateral access into a primary infusion line

61 P age 012017

enda Item 30Attachment B

May reinsert suprap ubic catheters in well-healed tract

May accept verbalphone orders No law - LPN s must follow from licensed physician or policies of employing facili ty registered nurse May only impl ement those orders that are within the LVN scope of

012017

arinization during

LVN who is Board-Certif ied in IV Therapy ca n maintain heparin lock using sa line or hepari n but cannot administer medications or solutions other than flu id solutions of electrolytes nutrients vitamins blood and blood Cannot perform Pap

SmearsGC cultures or check strin gs for IUD Ca n check fetal heart tones but ca n on ly count cannot assess Cannot perform

olds Maneuvers Can apply Unna Boots

Can loadmonitor PCA pumps administering subcutaneous medication Cannot load PCA pumps administering intravenous medication Can monitor pump and report status toRN when pump is adminis IV medication If LVN is Boa rd-certified in IV and Blood Withdrawa l the LVN ca n

bull Obtain blood specimens bull Connect and monitor flu id

solutions of electrolytes nutrients vitamins blood and blood products

bull Cannot connect IVPB unless it con tains flu id solutions of electrolytes nutrients vitamins blood and blood produ cts

bull Can provide site ca re includi

Can ca re for clien ts with internal venous access devices

dressi cha

Reinsertion of suprapubic catheters

Accept verbalphone orders directly from the prescriber (an optometrist advanced practice registered nurse physician dentist or psychologist)

Maintain and administer meds via heparin locks

Pap smearsGC cu lturesI UD string checksfund al heart tonesLeopolds m aneuvers

Apply Unn a Boots

Loadmonitor PCA machines

Care for clients with external venous ca theters (includ in g Hickman Groshong Brovia) and specifica lly obtain blood specimensconnect and monitor IV fluids connect IVPB provide site care (including dressi ng cha nges)

71 Pa ge

Care for clients with internal venous access devices

(including port-a-cath life port) and specifically access with andor remove Huber needledraw bloodconnect and monitor IV fluids (fluid solutions of electrolytes nutrients vitamins blood and blood products) and provide site care (includinq dressinq chanqes) Can perform head to toe physical examinations

A~g enda Item 30 Att h ac ment B (including port-a-cath life port) and specifically access with andor remove Huber needledraw bloodconnect and monitor IV fluids and provide site care (including dressing changes)

Perform head to toe physical assessments

Can reinsert tracheostomy tube in a well-healed tract

Reinsert a tracheostomy tube in an established tract

Can insert feeding tube in a neonate

Insert a feeding tube in a neonate

Remove sheaths in a cardiac cath lab and later dc these lines

An LVN can administer in-line nebulized medication If the ventilator breathing circuit is manipulated simply to establish a port for the medication such manipulation may be done by the LVN If the manipulation in any way changes the parameters of the ventilator delivery the LVN cannot perform such actions

Perform tasks which promote pulmonary health and hygiene (administer oxygen aerosol and IPPB treatments suction perform CPT etc) LPNS MAY NOT HOLD THEMSELVES OUT AS RESPIRATORY THERAPISTS OR RESPIRATORY THERAPY TECHNICIANS

The LVN may change the inner cannula of a tracheostomy during trach care and may disconnect the circuit to do so

The LVN cannot titrate oxygen liter flow to effect The L VN may adjust the flow in accordance with a specific order from the physician

In all cases the LVN must possess the knowledge skill and ability to perform the procedures safely and competently

8IPage 012017

Agenda Item 30Attachment C middot

BUSINESS AND PROFESSIONS CODE - BPC DIVISION 2 HEALING ARTS [500- 4999129]

(Division 2 enacted by Slats 1937 Ch 399) CHAPTER 83 Respiratory Therapy [3700 bull 3779] (Chapter 83 added by Stats 1982 Ch 1344 Sec 1)

ARTICLE 6 Offenses and Enforcement [3760- 37693] (Article 6 added by Stats 1982 Ch I 344 Sec 1 )

3760

(a) Except as otherwise provided in this chapter no person shall engage In the practice of respiratory care respiratory therapy or Inhalation therapy For purposes of this section engaging In the practice of respiratory care Includes but Is not limited to representations by a person whether through verbal claim sign advertisement letterhead business card or other representation that he or she is able to perform any respiratory care service or performance of any respiratory care service

(b) No person who Is unlicensed or whose respiratory care practitioner license has been revoked or suspended or whose license is not valid shall engage in the practice of respiratory care during the period of suspension or revocation even though the person may continue to hold a certificate or registration issued by a private certifying entity

(c) Except as otherwise provided in this chapter no person may represent himself or herself to be a respiratory care practitioner a respiratory therapist a respiratory care technician or an Inhalation therapist or use the abbreviation or letters RCP RP RT or IT or use any modifications or derivatives of those abbreviations or letters without a current and valid license issued under this chapter

(d) No respiratory care practitioner applicant shall begin practice as a respiratorymiddot care practitioner applicant pursLiant to Section 3739 until the applicant meets the applicable requirements of this chapter and obtains a valid work permit

(Amended by Stats 2003 Ch 586 Sec 14 Effective Jan(lary 1 2004)

(a) No person may practice respiratory care or represent himself or herself to be a middotmiddot -~-------resprratolV care prattltloTer-nnnls staremiddot withOm-a-validllcense grarttedlJtder~middot

this chapter except as otherwise provided in this chapter

(b) No person or corporation shall knowingly employ a person who holds himself or herself out to be a respiratory care practitioner without a valid license granted under this chapter except as otherwise provided In this chapter

(Amended by Stats 2003 Ch 586 Sec 15 Effective Jan(lary 1 2004)

1

Notlling in this chapter is Intended to limit preclude or otherwise Interfere with the practices of other llcensed personnel in carrying out authorized and customary duties and functions (Amended by Stats 1994 Ch 1274 Sec 25 Effective January 1 1995)

Jlli

Any person who violates any of the provisions of this chapter shall be guilty of a misdemeanor punisllable by a fine not exceeding one tllousanq dollars ($1000) or Imprisonment In a county jail not exceeding six months or both for each offense (Amended by Stats 1994 Ch 1274 Sec 26 Effective January 1 1995) middot

3764

Whenever any person has engaged or Is about to engage In any acts or practices that constitute or will constitute an offense against tills chapter the superior court of any county on application of the board the Medical Board of Callfornla or by 10 or more persons holding respiratory care practitioner licenses Issued under this chspter msy Issue sn injunction or other appropriate order restrslnlng that conduct Proceedings under this section sllall be governed by Chapter 3 (commencing with Section 525) of Title 7 of Part 2 of the Code of Civil ProcedLire except that no undertaking shall be required in any action commenced by the board (Amended by Stats 1995 Ch 279 Sec 23 Effective January 1 1996)

3765

This act does not prohibit any of the following activities

(a) The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs

(b) Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold himseff or herself out to be a respiratory care practitioner licensed under the provisions of this chapter

(c) The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or specialized training bull

(d) The psufiumancl oLrllipjritory_car~jJJ_an emetgellcY slt~IltJlQDJlYParamegical - _I personnel who have been formally tniined in these modalities and are duly licensed under the provisions of an act pertaining to their specialty

(e) Respiratory care services in case of an emergency Emermiddotgency as used In this subdivision Includes an epidemic or public disaster

(f) Persons from engaging in cardiopulmonary research

2

(g) Formally trained licensees and staff of child day care facilities from administering to a child Inhaled medication as defined in Section 1596798 of the Health and Safety Code

(h) The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the State Department of Public Health of specific limited and basic respiratory care or respiratory care related services that have been authorized by the board

(i) The performance of pulmonary function testing by persons who are currently employed by Los Angeles County hospitals and have performed pulmonary fLinctlon testing for at least 15 years

middot(Amended by Stats 2013 Ch 516 Sec 23 Effective January 1 2014)

(a) The board may issue a citation containing an order of abatement and civil penalties against a person who acts In the capacity of or engages In the business of a respiratory care practitioner In this state without having a license in good standing Issued pursuant to this chapter

(b) The board may Issue a citation containing an order of abatement and civil penalties against a person employing or contracting with a person who acts In the capacity of or engages In the business of a respiratory care practitioner in this state without having a license In good standing issued pursuant to this chapter

(Added by Stats 2002 Ch 1150 Sec 34 Effective January 1 2003)

(a) The board shall issue a citation to a person and to his or her employer or contractor if upon Inspection or Investigation either upon complaint or otherwise the following conditions are met (1) The board has probable cause to believe that the person is acting in

the capacity of or engaging In the practice of a respiratory care practitioner In this state without having a license in good standing issued pursuant to this chapter

(2) The person Is not otherwise exempted from the provisions of this chapter

(b) Each citation Issued pursuant to subdivision (a) shall meet all of the following -middot---middot--middot-----reqUirem-ents- middot - middot -- -middotmiddotmiddotmiddot--middot---middot-----middot--middotmiddot middot-middot middot middotmiddot- middot middot-middot ---middot--middotmiddot

(1) Be In writing and describe with particuladty the basis of the citation (2) Contain an order of abatement and an assessment of a civil penalty in

an amount not less than two hundred dollars ($200) nor more than fifteen thousand dollars ($15000)

(c) A person served with a citation may appeal to the board within 15 calendar clays after service of the citation with respect to any of the following (1) Tile violations alleged

3

(2) The scope of the order of abatement (3) The amount of the civil penalty assessed

(d) middot middot If within 15 calendar days after service of the citation the person cited falls to notify the board that he or she Intends to appeal the citation the citation shall be deemed a final order of the board and not subject to review by any court or agency The board may extend the 15-day period for good cause

(e) (1) If a person cited under this section notifies the board In a timely manner that he or she Intends to contest the citation the board shall afford an opportunity for a hearing

(2) The board shall thereaftEr issue a decision based on findings of fact affirming modifying or vacating the citation or directing other appropriate relief

(f) With the approval of the board the executive officer shall prescribe procedures for the issuance and appeal of a citation and procedures for a hearing under this section The board shall adopt regulations covering the assessment of a civil penalty that shall give due consideration to the gravity of the violation and any history of previous violations

(g) middotThe sanctions authorized under this section sl1all be separate from and In addition to any other civil or criminal remedies

(Added by Stats 2002 Ch 1150 Sec 35 Effective Jan11ary 1 2003)

(a) After the exhaustion of the review procedures provided for In Section 3767 and as adopted by regulation the board may apply to the appropriate superior court for both of the following (1) A judgment In the amount of the civil penalty (2) An order compelling the cited person to comply with the order of

abatement

(b) The application described In subdivision (a) shall include a certified copy of the final order of the board

(c) The application described In subdivision (a) shall constitute a sufficient showing to warrant the issuance of the judgment and ordermiddot

middotmiddotmiddot middot middot middotmiddot middotmiddot middot middot middot middot (ar--IITe-lloard may-employcollectlon-agenclesuruther methods-in-ordermiddotto-collect-- middot middot civil penalties

(Added by Stats 2002 Ch 1150 Sec 36 Effective January 1 2003)

37693

4

0 I

(a) Notwithstanding any other provision the board may by stipulation with the affected licensee issue a middotpublic reprimand after it has conducted an Investigation In lieu of filing or prosecuting a formal accusation

(b) The stipulation shall contain the authority grounds and causes and circumstances for taking such action and by way of waiving the affected licensees rights Inform the licensee of his or her rights to have a formal accusation filed and stipulate to a settlement thereafter or have the matter in the statement of Issues heard before an administrative law judge In accordance wltli the Administrative Procedure Act (Chapter 35 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code)

(c) The stipulation shall be public Information and shall be used as evidence in any future disciplinary or penalty action taken by the board

(Amended by Stats 2011 Ch 296 Sec 5 Effective January 1 2012)

5

2518 5 (b) Scope ofVN Provide nursing care under the Practice direction of a registered Provides direct patientclient professional nurse by care by which the licensee 33a caring for cl ients whose (1) Performs basic nursing cond itions are stabilized or services as defined in predictable subdivision (a)[seen above 33b assisting with clients (2) Administers medications whose conditions are criti cal (3) Applies communication skills andor fluctuating under the for the purpose of patientclient direct supervision of the care and education and registered professiona l nurse (4) Contributes to the 33c implem enting nursing care development and according to the priority of implementation of a teaching needs and established plan related to self-care for the practices patientclient 33d providing an environment

conducive to safety and health 3 3e documenting nursing interventions and responses to care and 33f communicating nursing interven tions and responses to care to appropriate members of the health team 34 Assign components of nursing care to other qualified persons and 35 Contribute to the evaluation of the responses of individuals and groups to nursing interventions by 35a monitoring the responses to nursing interventions 35b documenting and communicating assessment data to appropriate members of the health care team and 35c contributing to the modification of the strategy of care on the basis of the assessment data

3I P age 012017

10-3-4 Standard s Relating to the Licens ed Practi cal Nurses Responsibil ities as a Member of the Healt h Care Team The Licensed Practica l Nurse shall 4 1 be familiar with the statutes and rules governing nursing 42 clearly display on his or her name tag or other identification badge their licensing credential (LPN) 43 function within the legal boundaries of practica l nursing practice 44 accept responsibility for individual nursing actions competencies and behavior 45 function under the direction of a registered professional nurse licensed physician or licensed dentist 46 consult with the registered professional nurse to seek guidance in delivery of nursing care as necessary 47 obta in instru ction and supervision as necessa ry from the registered professional nurse when implementing nursing techniques or practices 48 retain accountability for the timely and accurate completion of tasks assigned to other qualified persons 49 function as a member of the health team 41 0 contribute to the formulation interpretation implementation and evaluation of the objectives and po licies related to practical nursing pra ctice within the employment setting 411 participate in the evaluation of nursing through peer review 4 12 report unsafe nursing practice to the Board and unsafe practice conditions to recognized legal authorities 413 conduct practice w ithout discrimination on the basis of age race religion sex sexual preference nationa l origin or hand

41 Page 012017

A enda Item 30 Att achment B~~ 414 respect the dignity and rights of clients regardless of social or economic status personal attributes or the nature of the health problem 415 respect the clients right to privacy by protecting confidential information unless obligated by law to disclose the information 416 respect the property of employers clients and their families and 417 participate in relevant continuing competence activities to maintain current knowledge and skill levels in practical nursing as required in West Virginia State Board of Examiners for Licensed Practical Nurses Rule Continuing Competence 10 CSR6

SIPage 012017

L VNs must be Board-certified (post-licensure certification) in IV Therapy

25421 Intravenous Therapy No laws exist and IV Therapy is Initiate and maintain IV therapy The Board will consider a not part of basic PN Program and administer IV medications licensed vocational nurse as IV Therapy is not prohibited if by IVPB andor IVP (including competent to start and LPN has been trained and is hyperalimentation blood and superimpose intravenous fluids adequately supervised blood products) via primary or secondary infusion lines who has completed one of the following (a) A course in intravenous therapy approved by the Board as defined in Section 25423 (b) Submitted certification satisfactory to the Board by one of the persons specified in Section 25424 that the licensee has been instructed in the subject areas specified in Section 25423 and that the licensee has the knowledge skills and abilities to safely practice venipuncture For further limitations see Business and Professions Code section 28605

2542 Definition As used in this Article (a) Intravenous fluids means fluid solutions of electrolytes nutrients vitamins blood and blood products (b) Superimpose means to connect a container of intravenous fluid to tubing through which another container of intravenous fluid has just been administered (c) Primary infusion line means the line which provides a direct infusion between the container and the peripheral vein (d) Secondary infusion line means a line which provides infusion through a lateral access into a primary infusion line

61 P age 012017

enda Item 30Attachment B

May reinsert suprap ubic catheters in well-healed tract

May accept verbalphone orders No law - LPN s must follow from licensed physician or policies of employing facili ty registered nurse May only impl ement those orders that are within the LVN scope of

012017

arinization during

LVN who is Board-Certif ied in IV Therapy ca n maintain heparin lock using sa line or hepari n but cannot administer medications or solutions other than flu id solutions of electrolytes nutrients vitamins blood and blood Cannot perform Pap

SmearsGC cultures or check strin gs for IUD Ca n check fetal heart tones but ca n on ly count cannot assess Cannot perform

olds Maneuvers Can apply Unna Boots

Can loadmonitor PCA pumps administering subcutaneous medication Cannot load PCA pumps administering intravenous medication Can monitor pump and report status toRN when pump is adminis IV medication If LVN is Boa rd-certified in IV and Blood Withdrawa l the LVN ca n

bull Obtain blood specimens bull Connect and monitor flu id

solutions of electrolytes nutrients vitamins blood and blood products

bull Cannot connect IVPB unless it con tains flu id solutions of electrolytes nutrients vitamins blood and blood produ cts

bull Can provide site ca re includi

Can ca re for clien ts with internal venous access devices

dressi cha

Reinsertion of suprapubic catheters

Accept verbalphone orders directly from the prescriber (an optometrist advanced practice registered nurse physician dentist or psychologist)

Maintain and administer meds via heparin locks

Pap smearsGC cu lturesI UD string checksfund al heart tonesLeopolds m aneuvers

Apply Unn a Boots

Loadmonitor PCA machines

Care for clients with external venous ca theters (includ in g Hickman Groshong Brovia) and specifica lly obtain blood specimensconnect and monitor IV fluids connect IVPB provide site care (including dressi ng cha nges)

71 Pa ge

Care for clients with internal venous access devices

(including port-a-cath life port) and specifically access with andor remove Huber needledraw bloodconnect and monitor IV fluids (fluid solutions of electrolytes nutrients vitamins blood and blood products) and provide site care (includinq dressinq chanqes) Can perform head to toe physical examinations

A~g enda Item 30 Att h ac ment B (including port-a-cath life port) and specifically access with andor remove Huber needledraw bloodconnect and monitor IV fluids and provide site care (including dressing changes)

Perform head to toe physical assessments

Can reinsert tracheostomy tube in a well-healed tract

Reinsert a tracheostomy tube in an established tract

Can insert feeding tube in a neonate

Insert a feeding tube in a neonate

Remove sheaths in a cardiac cath lab and later dc these lines

An LVN can administer in-line nebulized medication If the ventilator breathing circuit is manipulated simply to establish a port for the medication such manipulation may be done by the LVN If the manipulation in any way changes the parameters of the ventilator delivery the LVN cannot perform such actions

Perform tasks which promote pulmonary health and hygiene (administer oxygen aerosol and IPPB treatments suction perform CPT etc) LPNS MAY NOT HOLD THEMSELVES OUT AS RESPIRATORY THERAPISTS OR RESPIRATORY THERAPY TECHNICIANS

The LVN may change the inner cannula of a tracheostomy during trach care and may disconnect the circuit to do so

The LVN cannot titrate oxygen liter flow to effect The L VN may adjust the flow in accordance with a specific order from the physician

In all cases the LVN must possess the knowledge skill and ability to perform the procedures safely and competently

8IPage 012017

Agenda Item 30Attachment C middot

BUSINESS AND PROFESSIONS CODE - BPC DIVISION 2 HEALING ARTS [500- 4999129]

(Division 2 enacted by Slats 1937 Ch 399) CHAPTER 83 Respiratory Therapy [3700 bull 3779] (Chapter 83 added by Stats 1982 Ch 1344 Sec 1)

ARTICLE 6 Offenses and Enforcement [3760- 37693] (Article 6 added by Stats 1982 Ch I 344 Sec 1 )

3760

(a) Except as otherwise provided in this chapter no person shall engage In the practice of respiratory care respiratory therapy or Inhalation therapy For purposes of this section engaging In the practice of respiratory care Includes but Is not limited to representations by a person whether through verbal claim sign advertisement letterhead business card or other representation that he or she is able to perform any respiratory care service or performance of any respiratory care service

(b) No person who Is unlicensed or whose respiratory care practitioner license has been revoked or suspended or whose license is not valid shall engage in the practice of respiratory care during the period of suspension or revocation even though the person may continue to hold a certificate or registration issued by a private certifying entity

(c) Except as otherwise provided in this chapter no person may represent himself or herself to be a respiratory care practitioner a respiratory therapist a respiratory care technician or an Inhalation therapist or use the abbreviation or letters RCP RP RT or IT or use any modifications or derivatives of those abbreviations or letters without a current and valid license issued under this chapter

(d) No respiratory care practitioner applicant shall begin practice as a respiratorymiddot care practitioner applicant pursLiant to Section 3739 until the applicant meets the applicable requirements of this chapter and obtains a valid work permit

(Amended by Stats 2003 Ch 586 Sec 14 Effective Jan(lary 1 2004)

(a) No person may practice respiratory care or represent himself or herself to be a middotmiddot -~-------resprratolV care prattltloTer-nnnls staremiddot withOm-a-validllcense grarttedlJtder~middot

this chapter except as otherwise provided in this chapter

(b) No person or corporation shall knowingly employ a person who holds himself or herself out to be a respiratory care practitioner without a valid license granted under this chapter except as otherwise provided In this chapter

(Amended by Stats 2003 Ch 586 Sec 15 Effective Jan(lary 1 2004)

1

Notlling in this chapter is Intended to limit preclude or otherwise Interfere with the practices of other llcensed personnel in carrying out authorized and customary duties and functions (Amended by Stats 1994 Ch 1274 Sec 25 Effective January 1 1995)

Jlli

Any person who violates any of the provisions of this chapter shall be guilty of a misdemeanor punisllable by a fine not exceeding one tllousanq dollars ($1000) or Imprisonment In a county jail not exceeding six months or both for each offense (Amended by Stats 1994 Ch 1274 Sec 26 Effective January 1 1995) middot

3764

Whenever any person has engaged or Is about to engage In any acts or practices that constitute or will constitute an offense against tills chapter the superior court of any county on application of the board the Medical Board of Callfornla or by 10 or more persons holding respiratory care practitioner licenses Issued under this chspter msy Issue sn injunction or other appropriate order restrslnlng that conduct Proceedings under this section sllall be governed by Chapter 3 (commencing with Section 525) of Title 7 of Part 2 of the Code of Civil ProcedLire except that no undertaking shall be required in any action commenced by the board (Amended by Stats 1995 Ch 279 Sec 23 Effective January 1 1996)

3765

This act does not prohibit any of the following activities

(a) The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs

(b) Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold himseff or herself out to be a respiratory care practitioner licensed under the provisions of this chapter

(c) The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or specialized training bull

(d) The psufiumancl oLrllipjritory_car~jJJ_an emetgellcY slt~IltJlQDJlYParamegical - _I personnel who have been formally tniined in these modalities and are duly licensed under the provisions of an act pertaining to their specialty

(e) Respiratory care services in case of an emergency Emermiddotgency as used In this subdivision Includes an epidemic or public disaster

(f) Persons from engaging in cardiopulmonary research

2

(g) Formally trained licensees and staff of child day care facilities from administering to a child Inhaled medication as defined in Section 1596798 of the Health and Safety Code

(h) The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the State Department of Public Health of specific limited and basic respiratory care or respiratory care related services that have been authorized by the board

(i) The performance of pulmonary function testing by persons who are currently employed by Los Angeles County hospitals and have performed pulmonary fLinctlon testing for at least 15 years

middot(Amended by Stats 2013 Ch 516 Sec 23 Effective January 1 2014)

(a) The board may issue a citation containing an order of abatement and civil penalties against a person who acts In the capacity of or engages In the business of a respiratory care practitioner In this state without having a license in good standing Issued pursuant to this chapter

(b) The board may Issue a citation containing an order of abatement and civil penalties against a person employing or contracting with a person who acts In the capacity of or engages In the business of a respiratory care practitioner in this state without having a license In good standing issued pursuant to this chapter

(Added by Stats 2002 Ch 1150 Sec 34 Effective January 1 2003)

(a) The board shall issue a citation to a person and to his or her employer or contractor if upon Inspection or Investigation either upon complaint or otherwise the following conditions are met (1) The board has probable cause to believe that the person is acting in

the capacity of or engaging In the practice of a respiratory care practitioner In this state without having a license in good standing issued pursuant to this chapter

(2) The person Is not otherwise exempted from the provisions of this chapter

(b) Each citation Issued pursuant to subdivision (a) shall meet all of the following -middot---middot--middot-----reqUirem-ents- middot - middot -- -middotmiddotmiddotmiddot--middot---middot-----middot--middotmiddot middot-middot middot middotmiddot- middot middot-middot ---middot--middotmiddot

(1) Be In writing and describe with particuladty the basis of the citation (2) Contain an order of abatement and an assessment of a civil penalty in

an amount not less than two hundred dollars ($200) nor more than fifteen thousand dollars ($15000)

(c) A person served with a citation may appeal to the board within 15 calendar clays after service of the citation with respect to any of the following (1) Tile violations alleged

3

(2) The scope of the order of abatement (3) The amount of the civil penalty assessed

(d) middot middot If within 15 calendar days after service of the citation the person cited falls to notify the board that he or she Intends to appeal the citation the citation shall be deemed a final order of the board and not subject to review by any court or agency The board may extend the 15-day period for good cause

(e) (1) If a person cited under this section notifies the board In a timely manner that he or she Intends to contest the citation the board shall afford an opportunity for a hearing

(2) The board shall thereaftEr issue a decision based on findings of fact affirming modifying or vacating the citation or directing other appropriate relief

(f) With the approval of the board the executive officer shall prescribe procedures for the issuance and appeal of a citation and procedures for a hearing under this section The board shall adopt regulations covering the assessment of a civil penalty that shall give due consideration to the gravity of the violation and any history of previous violations

(g) middotThe sanctions authorized under this section sl1all be separate from and In addition to any other civil or criminal remedies

(Added by Stats 2002 Ch 1150 Sec 35 Effective Jan11ary 1 2003)

(a) After the exhaustion of the review procedures provided for In Section 3767 and as adopted by regulation the board may apply to the appropriate superior court for both of the following (1) A judgment In the amount of the civil penalty (2) An order compelling the cited person to comply with the order of

abatement

(b) The application described In subdivision (a) shall include a certified copy of the final order of the board

(c) The application described In subdivision (a) shall constitute a sufficient showing to warrant the issuance of the judgment and ordermiddot

middotmiddotmiddot middot middot middotmiddot middotmiddot middot middot middot middot (ar--IITe-lloard may-employcollectlon-agenclesuruther methods-in-ordermiddotto-collect-- middot middot civil penalties

(Added by Stats 2002 Ch 1150 Sec 36 Effective January 1 2003)

37693

4

0 I

(a) Notwithstanding any other provision the board may by stipulation with the affected licensee issue a middotpublic reprimand after it has conducted an Investigation In lieu of filing or prosecuting a formal accusation

(b) The stipulation shall contain the authority grounds and causes and circumstances for taking such action and by way of waiving the affected licensees rights Inform the licensee of his or her rights to have a formal accusation filed and stipulate to a settlement thereafter or have the matter in the statement of Issues heard before an administrative law judge In accordance wltli the Administrative Procedure Act (Chapter 35 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code)

(c) The stipulation shall be public Information and shall be used as evidence in any future disciplinary or penalty action taken by the board

(Amended by Stats 2011 Ch 296 Sec 5 Effective January 1 2012)

5

10-3-4 Standard s Relating to the Licens ed Practi cal Nurses Responsibil ities as a Member of the Healt h Care Team The Licensed Practica l Nurse shall 4 1 be familiar with the statutes and rules governing nursing 42 clearly display on his or her name tag or other identification badge their licensing credential (LPN) 43 function within the legal boundaries of practica l nursing practice 44 accept responsibility for individual nursing actions competencies and behavior 45 function under the direction of a registered professional nurse licensed physician or licensed dentist 46 consult with the registered professional nurse to seek guidance in delivery of nursing care as necessary 47 obta in instru ction and supervision as necessa ry from the registered professional nurse when implementing nursing techniques or practices 48 retain accountability for the timely and accurate completion of tasks assigned to other qualified persons 49 function as a member of the health team 41 0 contribute to the formulation interpretation implementation and evaluation of the objectives and po licies related to practical nursing pra ctice within the employment setting 411 participate in the evaluation of nursing through peer review 4 12 report unsafe nursing practice to the Board and unsafe practice conditions to recognized legal authorities 413 conduct practice w ithout discrimination on the basis of age race religion sex sexual preference nationa l origin or hand

41 Page 012017

A enda Item 30 Att achment B~~ 414 respect the dignity and rights of clients regardless of social or economic status personal attributes or the nature of the health problem 415 respect the clients right to privacy by protecting confidential information unless obligated by law to disclose the information 416 respect the property of employers clients and their families and 417 participate in relevant continuing competence activities to maintain current knowledge and skill levels in practical nursing as required in West Virginia State Board of Examiners for Licensed Practical Nurses Rule Continuing Competence 10 CSR6

SIPage 012017

L VNs must be Board-certified (post-licensure certification) in IV Therapy

25421 Intravenous Therapy No laws exist and IV Therapy is Initiate and maintain IV therapy The Board will consider a not part of basic PN Program and administer IV medications licensed vocational nurse as IV Therapy is not prohibited if by IVPB andor IVP (including competent to start and LPN has been trained and is hyperalimentation blood and superimpose intravenous fluids adequately supervised blood products) via primary or secondary infusion lines who has completed one of the following (a) A course in intravenous therapy approved by the Board as defined in Section 25423 (b) Submitted certification satisfactory to the Board by one of the persons specified in Section 25424 that the licensee has been instructed in the subject areas specified in Section 25423 and that the licensee has the knowledge skills and abilities to safely practice venipuncture For further limitations see Business and Professions Code section 28605

2542 Definition As used in this Article (a) Intravenous fluids means fluid solutions of electrolytes nutrients vitamins blood and blood products (b) Superimpose means to connect a container of intravenous fluid to tubing through which another container of intravenous fluid has just been administered (c) Primary infusion line means the line which provides a direct infusion between the container and the peripheral vein (d) Secondary infusion line means a line which provides infusion through a lateral access into a primary infusion line

61 P age 012017

enda Item 30Attachment B

May reinsert suprap ubic catheters in well-healed tract

May accept verbalphone orders No law - LPN s must follow from licensed physician or policies of employing facili ty registered nurse May only impl ement those orders that are within the LVN scope of

012017

arinization during

LVN who is Board-Certif ied in IV Therapy ca n maintain heparin lock using sa line or hepari n but cannot administer medications or solutions other than flu id solutions of electrolytes nutrients vitamins blood and blood Cannot perform Pap

SmearsGC cultures or check strin gs for IUD Ca n check fetal heart tones but ca n on ly count cannot assess Cannot perform

olds Maneuvers Can apply Unna Boots

Can loadmonitor PCA pumps administering subcutaneous medication Cannot load PCA pumps administering intravenous medication Can monitor pump and report status toRN when pump is adminis IV medication If LVN is Boa rd-certified in IV and Blood Withdrawa l the LVN ca n

bull Obtain blood specimens bull Connect and monitor flu id

solutions of electrolytes nutrients vitamins blood and blood products

bull Cannot connect IVPB unless it con tains flu id solutions of electrolytes nutrients vitamins blood and blood produ cts

bull Can provide site ca re includi

Can ca re for clien ts with internal venous access devices

dressi cha

Reinsertion of suprapubic catheters

Accept verbalphone orders directly from the prescriber (an optometrist advanced practice registered nurse physician dentist or psychologist)

Maintain and administer meds via heparin locks

Pap smearsGC cu lturesI UD string checksfund al heart tonesLeopolds m aneuvers

Apply Unn a Boots

Loadmonitor PCA machines

Care for clients with external venous ca theters (includ in g Hickman Groshong Brovia) and specifica lly obtain blood specimensconnect and monitor IV fluids connect IVPB provide site care (including dressi ng cha nges)

71 Pa ge

Care for clients with internal venous access devices

(including port-a-cath life port) and specifically access with andor remove Huber needledraw bloodconnect and monitor IV fluids (fluid solutions of electrolytes nutrients vitamins blood and blood products) and provide site care (includinq dressinq chanqes) Can perform head to toe physical examinations

A~g enda Item 30 Att h ac ment B (including port-a-cath life port) and specifically access with andor remove Huber needledraw bloodconnect and monitor IV fluids and provide site care (including dressing changes)

Perform head to toe physical assessments

Can reinsert tracheostomy tube in a well-healed tract

Reinsert a tracheostomy tube in an established tract

Can insert feeding tube in a neonate

Insert a feeding tube in a neonate

Remove sheaths in a cardiac cath lab and later dc these lines

An LVN can administer in-line nebulized medication If the ventilator breathing circuit is manipulated simply to establish a port for the medication such manipulation may be done by the LVN If the manipulation in any way changes the parameters of the ventilator delivery the LVN cannot perform such actions

Perform tasks which promote pulmonary health and hygiene (administer oxygen aerosol and IPPB treatments suction perform CPT etc) LPNS MAY NOT HOLD THEMSELVES OUT AS RESPIRATORY THERAPISTS OR RESPIRATORY THERAPY TECHNICIANS

The LVN may change the inner cannula of a tracheostomy during trach care and may disconnect the circuit to do so

The LVN cannot titrate oxygen liter flow to effect The L VN may adjust the flow in accordance with a specific order from the physician

In all cases the LVN must possess the knowledge skill and ability to perform the procedures safely and competently

8IPage 012017

Agenda Item 30Attachment C middot

BUSINESS AND PROFESSIONS CODE - BPC DIVISION 2 HEALING ARTS [500- 4999129]

(Division 2 enacted by Slats 1937 Ch 399) CHAPTER 83 Respiratory Therapy [3700 bull 3779] (Chapter 83 added by Stats 1982 Ch 1344 Sec 1)

ARTICLE 6 Offenses and Enforcement [3760- 37693] (Article 6 added by Stats 1982 Ch I 344 Sec 1 )

3760

(a) Except as otherwise provided in this chapter no person shall engage In the practice of respiratory care respiratory therapy or Inhalation therapy For purposes of this section engaging In the practice of respiratory care Includes but Is not limited to representations by a person whether through verbal claim sign advertisement letterhead business card or other representation that he or she is able to perform any respiratory care service or performance of any respiratory care service

(b) No person who Is unlicensed or whose respiratory care practitioner license has been revoked or suspended or whose license is not valid shall engage in the practice of respiratory care during the period of suspension or revocation even though the person may continue to hold a certificate or registration issued by a private certifying entity

(c) Except as otherwise provided in this chapter no person may represent himself or herself to be a respiratory care practitioner a respiratory therapist a respiratory care technician or an Inhalation therapist or use the abbreviation or letters RCP RP RT or IT or use any modifications or derivatives of those abbreviations or letters without a current and valid license issued under this chapter

(d) No respiratory care practitioner applicant shall begin practice as a respiratorymiddot care practitioner applicant pursLiant to Section 3739 until the applicant meets the applicable requirements of this chapter and obtains a valid work permit

(Amended by Stats 2003 Ch 586 Sec 14 Effective Jan(lary 1 2004)

(a) No person may practice respiratory care or represent himself or herself to be a middotmiddot -~-------resprratolV care prattltloTer-nnnls staremiddot withOm-a-validllcense grarttedlJtder~middot

this chapter except as otherwise provided in this chapter

(b) No person or corporation shall knowingly employ a person who holds himself or herself out to be a respiratory care practitioner without a valid license granted under this chapter except as otherwise provided In this chapter

(Amended by Stats 2003 Ch 586 Sec 15 Effective Jan(lary 1 2004)

1

Notlling in this chapter is Intended to limit preclude or otherwise Interfere with the practices of other llcensed personnel in carrying out authorized and customary duties and functions (Amended by Stats 1994 Ch 1274 Sec 25 Effective January 1 1995)

Jlli

Any person who violates any of the provisions of this chapter shall be guilty of a misdemeanor punisllable by a fine not exceeding one tllousanq dollars ($1000) or Imprisonment In a county jail not exceeding six months or both for each offense (Amended by Stats 1994 Ch 1274 Sec 26 Effective January 1 1995) middot

3764

Whenever any person has engaged or Is about to engage In any acts or practices that constitute or will constitute an offense against tills chapter the superior court of any county on application of the board the Medical Board of Callfornla or by 10 or more persons holding respiratory care practitioner licenses Issued under this chspter msy Issue sn injunction or other appropriate order restrslnlng that conduct Proceedings under this section sllall be governed by Chapter 3 (commencing with Section 525) of Title 7 of Part 2 of the Code of Civil ProcedLire except that no undertaking shall be required in any action commenced by the board (Amended by Stats 1995 Ch 279 Sec 23 Effective January 1 1996)

3765

This act does not prohibit any of the following activities

(a) The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs

(b) Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold himseff or herself out to be a respiratory care practitioner licensed under the provisions of this chapter

(c) The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or specialized training bull

(d) The psufiumancl oLrllipjritory_car~jJJ_an emetgellcY slt~IltJlQDJlYParamegical - _I personnel who have been formally tniined in these modalities and are duly licensed under the provisions of an act pertaining to their specialty

(e) Respiratory care services in case of an emergency Emermiddotgency as used In this subdivision Includes an epidemic or public disaster

(f) Persons from engaging in cardiopulmonary research

2

(g) Formally trained licensees and staff of child day care facilities from administering to a child Inhaled medication as defined in Section 1596798 of the Health and Safety Code

(h) The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the State Department of Public Health of specific limited and basic respiratory care or respiratory care related services that have been authorized by the board

(i) The performance of pulmonary function testing by persons who are currently employed by Los Angeles County hospitals and have performed pulmonary fLinctlon testing for at least 15 years

middot(Amended by Stats 2013 Ch 516 Sec 23 Effective January 1 2014)

(a) The board may issue a citation containing an order of abatement and civil penalties against a person who acts In the capacity of or engages In the business of a respiratory care practitioner In this state without having a license in good standing Issued pursuant to this chapter

(b) The board may Issue a citation containing an order of abatement and civil penalties against a person employing or contracting with a person who acts In the capacity of or engages In the business of a respiratory care practitioner in this state without having a license In good standing issued pursuant to this chapter

(Added by Stats 2002 Ch 1150 Sec 34 Effective January 1 2003)

(a) The board shall issue a citation to a person and to his or her employer or contractor if upon Inspection or Investigation either upon complaint or otherwise the following conditions are met (1) The board has probable cause to believe that the person is acting in

the capacity of or engaging In the practice of a respiratory care practitioner In this state without having a license in good standing issued pursuant to this chapter

(2) The person Is not otherwise exempted from the provisions of this chapter

(b) Each citation Issued pursuant to subdivision (a) shall meet all of the following -middot---middot--middot-----reqUirem-ents- middot - middot -- -middotmiddotmiddotmiddot--middot---middot-----middot--middotmiddot middot-middot middot middotmiddot- middot middot-middot ---middot--middotmiddot

(1) Be In writing and describe with particuladty the basis of the citation (2) Contain an order of abatement and an assessment of a civil penalty in

an amount not less than two hundred dollars ($200) nor more than fifteen thousand dollars ($15000)

(c) A person served with a citation may appeal to the board within 15 calendar clays after service of the citation with respect to any of the following (1) Tile violations alleged

3

(2) The scope of the order of abatement (3) The amount of the civil penalty assessed

(d) middot middot If within 15 calendar days after service of the citation the person cited falls to notify the board that he or she Intends to appeal the citation the citation shall be deemed a final order of the board and not subject to review by any court or agency The board may extend the 15-day period for good cause

(e) (1) If a person cited under this section notifies the board In a timely manner that he or she Intends to contest the citation the board shall afford an opportunity for a hearing

(2) The board shall thereaftEr issue a decision based on findings of fact affirming modifying or vacating the citation or directing other appropriate relief

(f) With the approval of the board the executive officer shall prescribe procedures for the issuance and appeal of a citation and procedures for a hearing under this section The board shall adopt regulations covering the assessment of a civil penalty that shall give due consideration to the gravity of the violation and any history of previous violations

(g) middotThe sanctions authorized under this section sl1all be separate from and In addition to any other civil or criminal remedies

(Added by Stats 2002 Ch 1150 Sec 35 Effective Jan11ary 1 2003)

(a) After the exhaustion of the review procedures provided for In Section 3767 and as adopted by regulation the board may apply to the appropriate superior court for both of the following (1) A judgment In the amount of the civil penalty (2) An order compelling the cited person to comply with the order of

abatement

(b) The application described In subdivision (a) shall include a certified copy of the final order of the board

(c) The application described In subdivision (a) shall constitute a sufficient showing to warrant the issuance of the judgment and ordermiddot

middotmiddotmiddot middot middot middotmiddot middotmiddot middot middot middot middot (ar--IITe-lloard may-employcollectlon-agenclesuruther methods-in-ordermiddotto-collect-- middot middot civil penalties

(Added by Stats 2002 Ch 1150 Sec 36 Effective January 1 2003)

37693

4

0 I

(a) Notwithstanding any other provision the board may by stipulation with the affected licensee issue a middotpublic reprimand after it has conducted an Investigation In lieu of filing or prosecuting a formal accusation

(b) The stipulation shall contain the authority grounds and causes and circumstances for taking such action and by way of waiving the affected licensees rights Inform the licensee of his or her rights to have a formal accusation filed and stipulate to a settlement thereafter or have the matter in the statement of Issues heard before an administrative law judge In accordance wltli the Administrative Procedure Act (Chapter 35 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code)

(c) The stipulation shall be public Information and shall be used as evidence in any future disciplinary or penalty action taken by the board

(Amended by Stats 2011 Ch 296 Sec 5 Effective January 1 2012)

5

A enda Item 30 Att achment B~~ 414 respect the dignity and rights of clients regardless of social or economic status personal attributes or the nature of the health problem 415 respect the clients right to privacy by protecting confidential information unless obligated by law to disclose the information 416 respect the property of employers clients and their families and 417 participate in relevant continuing competence activities to maintain current knowledge and skill levels in practical nursing as required in West Virginia State Board of Examiners for Licensed Practical Nurses Rule Continuing Competence 10 CSR6

SIPage 012017

L VNs must be Board-certified (post-licensure certification) in IV Therapy

25421 Intravenous Therapy No laws exist and IV Therapy is Initiate and maintain IV therapy The Board will consider a not part of basic PN Program and administer IV medications licensed vocational nurse as IV Therapy is not prohibited if by IVPB andor IVP (including competent to start and LPN has been trained and is hyperalimentation blood and superimpose intravenous fluids adequately supervised blood products) via primary or secondary infusion lines who has completed one of the following (a) A course in intravenous therapy approved by the Board as defined in Section 25423 (b) Submitted certification satisfactory to the Board by one of the persons specified in Section 25424 that the licensee has been instructed in the subject areas specified in Section 25423 and that the licensee has the knowledge skills and abilities to safely practice venipuncture For further limitations see Business and Professions Code section 28605

2542 Definition As used in this Article (a) Intravenous fluids means fluid solutions of electrolytes nutrients vitamins blood and blood products (b) Superimpose means to connect a container of intravenous fluid to tubing through which another container of intravenous fluid has just been administered (c) Primary infusion line means the line which provides a direct infusion between the container and the peripheral vein (d) Secondary infusion line means a line which provides infusion through a lateral access into a primary infusion line

61 P age 012017

enda Item 30Attachment B

May reinsert suprap ubic catheters in well-healed tract

May accept verbalphone orders No law - LPN s must follow from licensed physician or policies of employing facili ty registered nurse May only impl ement those orders that are within the LVN scope of

012017

arinization during

LVN who is Board-Certif ied in IV Therapy ca n maintain heparin lock using sa line or hepari n but cannot administer medications or solutions other than flu id solutions of electrolytes nutrients vitamins blood and blood Cannot perform Pap

SmearsGC cultures or check strin gs for IUD Ca n check fetal heart tones but ca n on ly count cannot assess Cannot perform

olds Maneuvers Can apply Unna Boots

Can loadmonitor PCA pumps administering subcutaneous medication Cannot load PCA pumps administering intravenous medication Can monitor pump and report status toRN when pump is adminis IV medication If LVN is Boa rd-certified in IV and Blood Withdrawa l the LVN ca n

bull Obtain blood specimens bull Connect and monitor flu id

solutions of electrolytes nutrients vitamins blood and blood products

bull Cannot connect IVPB unless it con tains flu id solutions of electrolytes nutrients vitamins blood and blood produ cts

bull Can provide site ca re includi

Can ca re for clien ts with internal venous access devices

dressi cha

Reinsertion of suprapubic catheters

Accept verbalphone orders directly from the prescriber (an optometrist advanced practice registered nurse physician dentist or psychologist)

Maintain and administer meds via heparin locks

Pap smearsGC cu lturesI UD string checksfund al heart tonesLeopolds m aneuvers

Apply Unn a Boots

Loadmonitor PCA machines

Care for clients with external venous ca theters (includ in g Hickman Groshong Brovia) and specifica lly obtain blood specimensconnect and monitor IV fluids connect IVPB provide site care (including dressi ng cha nges)

71 Pa ge

Care for clients with internal venous access devices

(including port-a-cath life port) and specifically access with andor remove Huber needledraw bloodconnect and monitor IV fluids (fluid solutions of electrolytes nutrients vitamins blood and blood products) and provide site care (includinq dressinq chanqes) Can perform head to toe physical examinations

A~g enda Item 30 Att h ac ment B (including port-a-cath life port) and specifically access with andor remove Huber needledraw bloodconnect and monitor IV fluids and provide site care (including dressing changes)

Perform head to toe physical assessments

Can reinsert tracheostomy tube in a well-healed tract

Reinsert a tracheostomy tube in an established tract

Can insert feeding tube in a neonate

Insert a feeding tube in a neonate

Remove sheaths in a cardiac cath lab and later dc these lines

An LVN can administer in-line nebulized medication If the ventilator breathing circuit is manipulated simply to establish a port for the medication such manipulation may be done by the LVN If the manipulation in any way changes the parameters of the ventilator delivery the LVN cannot perform such actions

Perform tasks which promote pulmonary health and hygiene (administer oxygen aerosol and IPPB treatments suction perform CPT etc) LPNS MAY NOT HOLD THEMSELVES OUT AS RESPIRATORY THERAPISTS OR RESPIRATORY THERAPY TECHNICIANS

The LVN may change the inner cannula of a tracheostomy during trach care and may disconnect the circuit to do so

The LVN cannot titrate oxygen liter flow to effect The L VN may adjust the flow in accordance with a specific order from the physician

In all cases the LVN must possess the knowledge skill and ability to perform the procedures safely and competently

8IPage 012017

Agenda Item 30Attachment C middot

BUSINESS AND PROFESSIONS CODE - BPC DIVISION 2 HEALING ARTS [500- 4999129]

(Division 2 enacted by Slats 1937 Ch 399) CHAPTER 83 Respiratory Therapy [3700 bull 3779] (Chapter 83 added by Stats 1982 Ch 1344 Sec 1)

ARTICLE 6 Offenses and Enforcement [3760- 37693] (Article 6 added by Stats 1982 Ch I 344 Sec 1 )

3760

(a) Except as otherwise provided in this chapter no person shall engage In the practice of respiratory care respiratory therapy or Inhalation therapy For purposes of this section engaging In the practice of respiratory care Includes but Is not limited to representations by a person whether through verbal claim sign advertisement letterhead business card or other representation that he or she is able to perform any respiratory care service or performance of any respiratory care service

(b) No person who Is unlicensed or whose respiratory care practitioner license has been revoked or suspended or whose license is not valid shall engage in the practice of respiratory care during the period of suspension or revocation even though the person may continue to hold a certificate or registration issued by a private certifying entity

(c) Except as otherwise provided in this chapter no person may represent himself or herself to be a respiratory care practitioner a respiratory therapist a respiratory care technician or an Inhalation therapist or use the abbreviation or letters RCP RP RT or IT or use any modifications or derivatives of those abbreviations or letters without a current and valid license issued under this chapter

(d) No respiratory care practitioner applicant shall begin practice as a respiratorymiddot care practitioner applicant pursLiant to Section 3739 until the applicant meets the applicable requirements of this chapter and obtains a valid work permit

(Amended by Stats 2003 Ch 586 Sec 14 Effective Jan(lary 1 2004)

(a) No person may practice respiratory care or represent himself or herself to be a middotmiddot -~-------resprratolV care prattltloTer-nnnls staremiddot withOm-a-validllcense grarttedlJtder~middot

this chapter except as otherwise provided in this chapter

(b) No person or corporation shall knowingly employ a person who holds himself or herself out to be a respiratory care practitioner without a valid license granted under this chapter except as otherwise provided In this chapter

(Amended by Stats 2003 Ch 586 Sec 15 Effective Jan(lary 1 2004)

1

Notlling in this chapter is Intended to limit preclude or otherwise Interfere with the practices of other llcensed personnel in carrying out authorized and customary duties and functions (Amended by Stats 1994 Ch 1274 Sec 25 Effective January 1 1995)

Jlli

Any person who violates any of the provisions of this chapter shall be guilty of a misdemeanor punisllable by a fine not exceeding one tllousanq dollars ($1000) or Imprisonment In a county jail not exceeding six months or both for each offense (Amended by Stats 1994 Ch 1274 Sec 26 Effective January 1 1995) middot

3764

Whenever any person has engaged or Is about to engage In any acts or practices that constitute or will constitute an offense against tills chapter the superior court of any county on application of the board the Medical Board of Callfornla or by 10 or more persons holding respiratory care practitioner licenses Issued under this chspter msy Issue sn injunction or other appropriate order restrslnlng that conduct Proceedings under this section sllall be governed by Chapter 3 (commencing with Section 525) of Title 7 of Part 2 of the Code of Civil ProcedLire except that no undertaking shall be required in any action commenced by the board (Amended by Stats 1995 Ch 279 Sec 23 Effective January 1 1996)

3765

This act does not prohibit any of the following activities

(a) The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs

(b) Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold himseff or herself out to be a respiratory care practitioner licensed under the provisions of this chapter

(c) The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or specialized training bull

(d) The psufiumancl oLrllipjritory_car~jJJ_an emetgellcY slt~IltJlQDJlYParamegical - _I personnel who have been formally tniined in these modalities and are duly licensed under the provisions of an act pertaining to their specialty

(e) Respiratory care services in case of an emergency Emermiddotgency as used In this subdivision Includes an epidemic or public disaster

(f) Persons from engaging in cardiopulmonary research

2

(g) Formally trained licensees and staff of child day care facilities from administering to a child Inhaled medication as defined in Section 1596798 of the Health and Safety Code

(h) The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the State Department of Public Health of specific limited and basic respiratory care or respiratory care related services that have been authorized by the board

(i) The performance of pulmonary function testing by persons who are currently employed by Los Angeles County hospitals and have performed pulmonary fLinctlon testing for at least 15 years

middot(Amended by Stats 2013 Ch 516 Sec 23 Effective January 1 2014)

(a) The board may issue a citation containing an order of abatement and civil penalties against a person who acts In the capacity of or engages In the business of a respiratory care practitioner In this state without having a license in good standing Issued pursuant to this chapter

(b) The board may Issue a citation containing an order of abatement and civil penalties against a person employing or contracting with a person who acts In the capacity of or engages In the business of a respiratory care practitioner in this state without having a license In good standing issued pursuant to this chapter

(Added by Stats 2002 Ch 1150 Sec 34 Effective January 1 2003)

(a) The board shall issue a citation to a person and to his or her employer or contractor if upon Inspection or Investigation either upon complaint or otherwise the following conditions are met (1) The board has probable cause to believe that the person is acting in

the capacity of or engaging In the practice of a respiratory care practitioner In this state without having a license in good standing issued pursuant to this chapter

(2) The person Is not otherwise exempted from the provisions of this chapter

(b) Each citation Issued pursuant to subdivision (a) shall meet all of the following -middot---middot--middot-----reqUirem-ents- middot - middot -- -middotmiddotmiddotmiddot--middot---middot-----middot--middotmiddot middot-middot middot middotmiddot- middot middot-middot ---middot--middotmiddot

(1) Be In writing and describe with particuladty the basis of the citation (2) Contain an order of abatement and an assessment of a civil penalty in

an amount not less than two hundred dollars ($200) nor more than fifteen thousand dollars ($15000)

(c) A person served with a citation may appeal to the board within 15 calendar clays after service of the citation with respect to any of the following (1) Tile violations alleged

3

(2) The scope of the order of abatement (3) The amount of the civil penalty assessed

(d) middot middot If within 15 calendar days after service of the citation the person cited falls to notify the board that he or she Intends to appeal the citation the citation shall be deemed a final order of the board and not subject to review by any court or agency The board may extend the 15-day period for good cause

(e) (1) If a person cited under this section notifies the board In a timely manner that he or she Intends to contest the citation the board shall afford an opportunity for a hearing

(2) The board shall thereaftEr issue a decision based on findings of fact affirming modifying or vacating the citation or directing other appropriate relief

(f) With the approval of the board the executive officer shall prescribe procedures for the issuance and appeal of a citation and procedures for a hearing under this section The board shall adopt regulations covering the assessment of a civil penalty that shall give due consideration to the gravity of the violation and any history of previous violations

(g) middotThe sanctions authorized under this section sl1all be separate from and In addition to any other civil or criminal remedies

(Added by Stats 2002 Ch 1150 Sec 35 Effective Jan11ary 1 2003)

(a) After the exhaustion of the review procedures provided for In Section 3767 and as adopted by regulation the board may apply to the appropriate superior court for both of the following (1) A judgment In the amount of the civil penalty (2) An order compelling the cited person to comply with the order of

abatement

(b) The application described In subdivision (a) shall include a certified copy of the final order of the board

(c) The application described In subdivision (a) shall constitute a sufficient showing to warrant the issuance of the judgment and ordermiddot

middotmiddotmiddot middot middot middotmiddot middotmiddot middot middot middot middot (ar--IITe-lloard may-employcollectlon-agenclesuruther methods-in-ordermiddotto-collect-- middot middot civil penalties

(Added by Stats 2002 Ch 1150 Sec 36 Effective January 1 2003)

37693

4

0 I

(a) Notwithstanding any other provision the board may by stipulation with the affected licensee issue a middotpublic reprimand after it has conducted an Investigation In lieu of filing or prosecuting a formal accusation

(b) The stipulation shall contain the authority grounds and causes and circumstances for taking such action and by way of waiving the affected licensees rights Inform the licensee of his or her rights to have a formal accusation filed and stipulate to a settlement thereafter or have the matter in the statement of Issues heard before an administrative law judge In accordance wltli the Administrative Procedure Act (Chapter 35 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code)

(c) The stipulation shall be public Information and shall be used as evidence in any future disciplinary or penalty action taken by the board

(Amended by Stats 2011 Ch 296 Sec 5 Effective January 1 2012)

5

L VNs must be Board-certified (post-licensure certification) in IV Therapy

25421 Intravenous Therapy No laws exist and IV Therapy is Initiate and maintain IV therapy The Board will consider a not part of basic PN Program and administer IV medications licensed vocational nurse as IV Therapy is not prohibited if by IVPB andor IVP (including competent to start and LPN has been trained and is hyperalimentation blood and superimpose intravenous fluids adequately supervised blood products) via primary or secondary infusion lines who has completed one of the following (a) A course in intravenous therapy approved by the Board as defined in Section 25423 (b) Submitted certification satisfactory to the Board by one of the persons specified in Section 25424 that the licensee has been instructed in the subject areas specified in Section 25423 and that the licensee has the knowledge skills and abilities to safely practice venipuncture For further limitations see Business and Professions Code section 28605

2542 Definition As used in this Article (a) Intravenous fluids means fluid solutions of electrolytes nutrients vitamins blood and blood products (b) Superimpose means to connect a container of intravenous fluid to tubing through which another container of intravenous fluid has just been administered (c) Primary infusion line means the line which provides a direct infusion between the container and the peripheral vein (d) Secondary infusion line means a line which provides infusion through a lateral access into a primary infusion line

61 P age 012017

enda Item 30Attachment B

May reinsert suprap ubic catheters in well-healed tract

May accept verbalphone orders No law - LPN s must follow from licensed physician or policies of employing facili ty registered nurse May only impl ement those orders that are within the LVN scope of

012017

arinization during

LVN who is Board-Certif ied in IV Therapy ca n maintain heparin lock using sa line or hepari n but cannot administer medications or solutions other than flu id solutions of electrolytes nutrients vitamins blood and blood Cannot perform Pap

SmearsGC cultures or check strin gs for IUD Ca n check fetal heart tones but ca n on ly count cannot assess Cannot perform

olds Maneuvers Can apply Unna Boots

Can loadmonitor PCA pumps administering subcutaneous medication Cannot load PCA pumps administering intravenous medication Can monitor pump and report status toRN when pump is adminis IV medication If LVN is Boa rd-certified in IV and Blood Withdrawa l the LVN ca n

bull Obtain blood specimens bull Connect and monitor flu id

solutions of electrolytes nutrients vitamins blood and blood products

bull Cannot connect IVPB unless it con tains flu id solutions of electrolytes nutrients vitamins blood and blood produ cts

bull Can provide site ca re includi

Can ca re for clien ts with internal venous access devices

dressi cha

Reinsertion of suprapubic catheters

Accept verbalphone orders directly from the prescriber (an optometrist advanced practice registered nurse physician dentist or psychologist)

Maintain and administer meds via heparin locks

Pap smearsGC cu lturesI UD string checksfund al heart tonesLeopolds m aneuvers

Apply Unn a Boots

Loadmonitor PCA machines

Care for clients with external venous ca theters (includ in g Hickman Groshong Brovia) and specifica lly obtain blood specimensconnect and monitor IV fluids connect IVPB provide site care (including dressi ng cha nges)

71 Pa ge

Care for clients with internal venous access devices

(including port-a-cath life port) and specifically access with andor remove Huber needledraw bloodconnect and monitor IV fluids (fluid solutions of electrolytes nutrients vitamins blood and blood products) and provide site care (includinq dressinq chanqes) Can perform head to toe physical examinations

A~g enda Item 30 Att h ac ment B (including port-a-cath life port) and specifically access with andor remove Huber needledraw bloodconnect and monitor IV fluids and provide site care (including dressing changes)

Perform head to toe physical assessments

Can reinsert tracheostomy tube in a well-healed tract

Reinsert a tracheostomy tube in an established tract

Can insert feeding tube in a neonate

Insert a feeding tube in a neonate

Remove sheaths in a cardiac cath lab and later dc these lines

An LVN can administer in-line nebulized medication If the ventilator breathing circuit is manipulated simply to establish a port for the medication such manipulation may be done by the LVN If the manipulation in any way changes the parameters of the ventilator delivery the LVN cannot perform such actions

Perform tasks which promote pulmonary health and hygiene (administer oxygen aerosol and IPPB treatments suction perform CPT etc) LPNS MAY NOT HOLD THEMSELVES OUT AS RESPIRATORY THERAPISTS OR RESPIRATORY THERAPY TECHNICIANS

The LVN may change the inner cannula of a tracheostomy during trach care and may disconnect the circuit to do so

The LVN cannot titrate oxygen liter flow to effect The L VN may adjust the flow in accordance with a specific order from the physician

In all cases the LVN must possess the knowledge skill and ability to perform the procedures safely and competently

8IPage 012017

Agenda Item 30Attachment C middot

BUSINESS AND PROFESSIONS CODE - BPC DIVISION 2 HEALING ARTS [500- 4999129]

(Division 2 enacted by Slats 1937 Ch 399) CHAPTER 83 Respiratory Therapy [3700 bull 3779] (Chapter 83 added by Stats 1982 Ch 1344 Sec 1)

ARTICLE 6 Offenses and Enforcement [3760- 37693] (Article 6 added by Stats 1982 Ch I 344 Sec 1 )

3760

(a) Except as otherwise provided in this chapter no person shall engage In the practice of respiratory care respiratory therapy or Inhalation therapy For purposes of this section engaging In the practice of respiratory care Includes but Is not limited to representations by a person whether through verbal claim sign advertisement letterhead business card or other representation that he or she is able to perform any respiratory care service or performance of any respiratory care service

(b) No person who Is unlicensed or whose respiratory care practitioner license has been revoked or suspended or whose license is not valid shall engage in the practice of respiratory care during the period of suspension or revocation even though the person may continue to hold a certificate or registration issued by a private certifying entity

(c) Except as otherwise provided in this chapter no person may represent himself or herself to be a respiratory care practitioner a respiratory therapist a respiratory care technician or an Inhalation therapist or use the abbreviation or letters RCP RP RT or IT or use any modifications or derivatives of those abbreviations or letters without a current and valid license issued under this chapter

(d) No respiratory care practitioner applicant shall begin practice as a respiratorymiddot care practitioner applicant pursLiant to Section 3739 until the applicant meets the applicable requirements of this chapter and obtains a valid work permit

(Amended by Stats 2003 Ch 586 Sec 14 Effective Jan(lary 1 2004)

(a) No person may practice respiratory care or represent himself or herself to be a middotmiddot -~-------resprratolV care prattltloTer-nnnls staremiddot withOm-a-validllcense grarttedlJtder~middot

this chapter except as otherwise provided in this chapter

(b) No person or corporation shall knowingly employ a person who holds himself or herself out to be a respiratory care practitioner without a valid license granted under this chapter except as otherwise provided In this chapter

(Amended by Stats 2003 Ch 586 Sec 15 Effective Jan(lary 1 2004)

1

Notlling in this chapter is Intended to limit preclude or otherwise Interfere with the practices of other llcensed personnel in carrying out authorized and customary duties and functions (Amended by Stats 1994 Ch 1274 Sec 25 Effective January 1 1995)

Jlli

Any person who violates any of the provisions of this chapter shall be guilty of a misdemeanor punisllable by a fine not exceeding one tllousanq dollars ($1000) or Imprisonment In a county jail not exceeding six months or both for each offense (Amended by Stats 1994 Ch 1274 Sec 26 Effective January 1 1995) middot

3764

Whenever any person has engaged or Is about to engage In any acts or practices that constitute or will constitute an offense against tills chapter the superior court of any county on application of the board the Medical Board of Callfornla or by 10 or more persons holding respiratory care practitioner licenses Issued under this chspter msy Issue sn injunction or other appropriate order restrslnlng that conduct Proceedings under this section sllall be governed by Chapter 3 (commencing with Section 525) of Title 7 of Part 2 of the Code of Civil ProcedLire except that no undertaking shall be required in any action commenced by the board (Amended by Stats 1995 Ch 279 Sec 23 Effective January 1 1996)

3765

This act does not prohibit any of the following activities

(a) The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs

(b) Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold himseff or herself out to be a respiratory care practitioner licensed under the provisions of this chapter

(c) The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or specialized training bull

(d) The psufiumancl oLrllipjritory_car~jJJ_an emetgellcY slt~IltJlQDJlYParamegical - _I personnel who have been formally tniined in these modalities and are duly licensed under the provisions of an act pertaining to their specialty

(e) Respiratory care services in case of an emergency Emermiddotgency as used In this subdivision Includes an epidemic or public disaster

(f) Persons from engaging in cardiopulmonary research

2

(g) Formally trained licensees and staff of child day care facilities from administering to a child Inhaled medication as defined in Section 1596798 of the Health and Safety Code

(h) The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the State Department of Public Health of specific limited and basic respiratory care or respiratory care related services that have been authorized by the board

(i) The performance of pulmonary function testing by persons who are currently employed by Los Angeles County hospitals and have performed pulmonary fLinctlon testing for at least 15 years

middot(Amended by Stats 2013 Ch 516 Sec 23 Effective January 1 2014)

(a) The board may issue a citation containing an order of abatement and civil penalties against a person who acts In the capacity of or engages In the business of a respiratory care practitioner In this state without having a license in good standing Issued pursuant to this chapter

(b) The board may Issue a citation containing an order of abatement and civil penalties against a person employing or contracting with a person who acts In the capacity of or engages In the business of a respiratory care practitioner in this state without having a license In good standing issued pursuant to this chapter

(Added by Stats 2002 Ch 1150 Sec 34 Effective January 1 2003)

(a) The board shall issue a citation to a person and to his or her employer or contractor if upon Inspection or Investigation either upon complaint or otherwise the following conditions are met (1) The board has probable cause to believe that the person is acting in

the capacity of or engaging In the practice of a respiratory care practitioner In this state without having a license in good standing issued pursuant to this chapter

(2) The person Is not otherwise exempted from the provisions of this chapter

(b) Each citation Issued pursuant to subdivision (a) shall meet all of the following -middot---middot--middot-----reqUirem-ents- middot - middot -- -middotmiddotmiddotmiddot--middot---middot-----middot--middotmiddot middot-middot middot middotmiddot- middot middot-middot ---middot--middotmiddot

(1) Be In writing and describe with particuladty the basis of the citation (2) Contain an order of abatement and an assessment of a civil penalty in

an amount not less than two hundred dollars ($200) nor more than fifteen thousand dollars ($15000)

(c) A person served with a citation may appeal to the board within 15 calendar clays after service of the citation with respect to any of the following (1) Tile violations alleged

3

(2) The scope of the order of abatement (3) The amount of the civil penalty assessed

(d) middot middot If within 15 calendar days after service of the citation the person cited falls to notify the board that he or she Intends to appeal the citation the citation shall be deemed a final order of the board and not subject to review by any court or agency The board may extend the 15-day period for good cause

(e) (1) If a person cited under this section notifies the board In a timely manner that he or she Intends to contest the citation the board shall afford an opportunity for a hearing

(2) The board shall thereaftEr issue a decision based on findings of fact affirming modifying or vacating the citation or directing other appropriate relief

(f) With the approval of the board the executive officer shall prescribe procedures for the issuance and appeal of a citation and procedures for a hearing under this section The board shall adopt regulations covering the assessment of a civil penalty that shall give due consideration to the gravity of the violation and any history of previous violations

(g) middotThe sanctions authorized under this section sl1all be separate from and In addition to any other civil or criminal remedies

(Added by Stats 2002 Ch 1150 Sec 35 Effective Jan11ary 1 2003)

(a) After the exhaustion of the review procedures provided for In Section 3767 and as adopted by regulation the board may apply to the appropriate superior court for both of the following (1) A judgment In the amount of the civil penalty (2) An order compelling the cited person to comply with the order of

abatement

(b) The application described In subdivision (a) shall include a certified copy of the final order of the board

(c) The application described In subdivision (a) shall constitute a sufficient showing to warrant the issuance of the judgment and ordermiddot

middotmiddotmiddot middot middot middotmiddot middotmiddot middot middot middot middot (ar--IITe-lloard may-employcollectlon-agenclesuruther methods-in-ordermiddotto-collect-- middot middot civil penalties

(Added by Stats 2002 Ch 1150 Sec 36 Effective January 1 2003)

37693

4

0 I

(a) Notwithstanding any other provision the board may by stipulation with the affected licensee issue a middotpublic reprimand after it has conducted an Investigation In lieu of filing or prosecuting a formal accusation

(b) The stipulation shall contain the authority grounds and causes and circumstances for taking such action and by way of waiving the affected licensees rights Inform the licensee of his or her rights to have a formal accusation filed and stipulate to a settlement thereafter or have the matter in the statement of Issues heard before an administrative law judge In accordance wltli the Administrative Procedure Act (Chapter 35 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code)

(c) The stipulation shall be public Information and shall be used as evidence in any future disciplinary or penalty action taken by the board

(Amended by Stats 2011 Ch 296 Sec 5 Effective January 1 2012)

5

enda Item 30Attachment B

May reinsert suprap ubic catheters in well-healed tract

May accept verbalphone orders No law - LPN s must follow from licensed physician or policies of employing facili ty registered nurse May only impl ement those orders that are within the LVN scope of

012017

arinization during

LVN who is Board-Certif ied in IV Therapy ca n maintain heparin lock using sa line or hepari n but cannot administer medications or solutions other than flu id solutions of electrolytes nutrients vitamins blood and blood Cannot perform Pap

SmearsGC cultures or check strin gs for IUD Ca n check fetal heart tones but ca n on ly count cannot assess Cannot perform

olds Maneuvers Can apply Unna Boots

Can loadmonitor PCA pumps administering subcutaneous medication Cannot load PCA pumps administering intravenous medication Can monitor pump and report status toRN when pump is adminis IV medication If LVN is Boa rd-certified in IV and Blood Withdrawa l the LVN ca n

bull Obtain blood specimens bull Connect and monitor flu id

solutions of electrolytes nutrients vitamins blood and blood products

bull Cannot connect IVPB unless it con tains flu id solutions of electrolytes nutrients vitamins blood and blood produ cts

bull Can provide site ca re includi

Can ca re for clien ts with internal venous access devices

dressi cha

Reinsertion of suprapubic catheters

Accept verbalphone orders directly from the prescriber (an optometrist advanced practice registered nurse physician dentist or psychologist)

Maintain and administer meds via heparin locks

Pap smearsGC cu lturesI UD string checksfund al heart tonesLeopolds m aneuvers

Apply Unn a Boots

Loadmonitor PCA machines

Care for clients with external venous ca theters (includ in g Hickman Groshong Brovia) and specifica lly obtain blood specimensconnect and monitor IV fluids connect IVPB provide site care (including dressi ng cha nges)

71 Pa ge

Care for clients with internal venous access devices

(including port-a-cath life port) and specifically access with andor remove Huber needledraw bloodconnect and monitor IV fluids (fluid solutions of electrolytes nutrients vitamins blood and blood products) and provide site care (includinq dressinq chanqes) Can perform head to toe physical examinations

A~g enda Item 30 Att h ac ment B (including port-a-cath life port) and specifically access with andor remove Huber needledraw bloodconnect and monitor IV fluids and provide site care (including dressing changes)

Perform head to toe physical assessments

Can reinsert tracheostomy tube in a well-healed tract

Reinsert a tracheostomy tube in an established tract

Can insert feeding tube in a neonate

Insert a feeding tube in a neonate

Remove sheaths in a cardiac cath lab and later dc these lines

An LVN can administer in-line nebulized medication If the ventilator breathing circuit is manipulated simply to establish a port for the medication such manipulation may be done by the LVN If the manipulation in any way changes the parameters of the ventilator delivery the LVN cannot perform such actions

Perform tasks which promote pulmonary health and hygiene (administer oxygen aerosol and IPPB treatments suction perform CPT etc) LPNS MAY NOT HOLD THEMSELVES OUT AS RESPIRATORY THERAPISTS OR RESPIRATORY THERAPY TECHNICIANS

The LVN may change the inner cannula of a tracheostomy during trach care and may disconnect the circuit to do so

The LVN cannot titrate oxygen liter flow to effect The L VN may adjust the flow in accordance with a specific order from the physician

In all cases the LVN must possess the knowledge skill and ability to perform the procedures safely and competently

8IPage 012017

Agenda Item 30Attachment C middot

BUSINESS AND PROFESSIONS CODE - BPC DIVISION 2 HEALING ARTS [500- 4999129]

(Division 2 enacted by Slats 1937 Ch 399) CHAPTER 83 Respiratory Therapy [3700 bull 3779] (Chapter 83 added by Stats 1982 Ch 1344 Sec 1)

ARTICLE 6 Offenses and Enforcement [3760- 37693] (Article 6 added by Stats 1982 Ch I 344 Sec 1 )

3760

(a) Except as otherwise provided in this chapter no person shall engage In the practice of respiratory care respiratory therapy or Inhalation therapy For purposes of this section engaging In the practice of respiratory care Includes but Is not limited to representations by a person whether through verbal claim sign advertisement letterhead business card or other representation that he or she is able to perform any respiratory care service or performance of any respiratory care service

(b) No person who Is unlicensed or whose respiratory care practitioner license has been revoked or suspended or whose license is not valid shall engage in the practice of respiratory care during the period of suspension or revocation even though the person may continue to hold a certificate or registration issued by a private certifying entity

(c) Except as otherwise provided in this chapter no person may represent himself or herself to be a respiratory care practitioner a respiratory therapist a respiratory care technician or an Inhalation therapist or use the abbreviation or letters RCP RP RT or IT or use any modifications or derivatives of those abbreviations or letters without a current and valid license issued under this chapter

(d) No respiratory care practitioner applicant shall begin practice as a respiratorymiddot care practitioner applicant pursLiant to Section 3739 until the applicant meets the applicable requirements of this chapter and obtains a valid work permit

(Amended by Stats 2003 Ch 586 Sec 14 Effective Jan(lary 1 2004)

(a) No person may practice respiratory care or represent himself or herself to be a middotmiddot -~-------resprratolV care prattltloTer-nnnls staremiddot withOm-a-validllcense grarttedlJtder~middot

this chapter except as otherwise provided in this chapter

(b) No person or corporation shall knowingly employ a person who holds himself or herself out to be a respiratory care practitioner without a valid license granted under this chapter except as otherwise provided In this chapter

(Amended by Stats 2003 Ch 586 Sec 15 Effective Jan(lary 1 2004)

1

Notlling in this chapter is Intended to limit preclude or otherwise Interfere with the practices of other llcensed personnel in carrying out authorized and customary duties and functions (Amended by Stats 1994 Ch 1274 Sec 25 Effective January 1 1995)

Jlli

Any person who violates any of the provisions of this chapter shall be guilty of a misdemeanor punisllable by a fine not exceeding one tllousanq dollars ($1000) or Imprisonment In a county jail not exceeding six months or both for each offense (Amended by Stats 1994 Ch 1274 Sec 26 Effective January 1 1995) middot

3764

Whenever any person has engaged or Is about to engage In any acts or practices that constitute or will constitute an offense against tills chapter the superior court of any county on application of the board the Medical Board of Callfornla or by 10 or more persons holding respiratory care practitioner licenses Issued under this chspter msy Issue sn injunction or other appropriate order restrslnlng that conduct Proceedings under this section sllall be governed by Chapter 3 (commencing with Section 525) of Title 7 of Part 2 of the Code of Civil ProcedLire except that no undertaking shall be required in any action commenced by the board (Amended by Stats 1995 Ch 279 Sec 23 Effective January 1 1996)

3765

This act does not prohibit any of the following activities

(a) The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs

(b) Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold himseff or herself out to be a respiratory care practitioner licensed under the provisions of this chapter

(c) The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or specialized training bull

(d) The psufiumancl oLrllipjritory_car~jJJ_an emetgellcY slt~IltJlQDJlYParamegical - _I personnel who have been formally tniined in these modalities and are duly licensed under the provisions of an act pertaining to their specialty

(e) Respiratory care services in case of an emergency Emermiddotgency as used In this subdivision Includes an epidemic or public disaster

(f) Persons from engaging in cardiopulmonary research

2

(g) Formally trained licensees and staff of child day care facilities from administering to a child Inhaled medication as defined in Section 1596798 of the Health and Safety Code

(h) The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the State Department of Public Health of specific limited and basic respiratory care or respiratory care related services that have been authorized by the board

(i) The performance of pulmonary function testing by persons who are currently employed by Los Angeles County hospitals and have performed pulmonary fLinctlon testing for at least 15 years

middot(Amended by Stats 2013 Ch 516 Sec 23 Effective January 1 2014)

(a) The board may issue a citation containing an order of abatement and civil penalties against a person who acts In the capacity of or engages In the business of a respiratory care practitioner In this state without having a license in good standing Issued pursuant to this chapter

(b) The board may Issue a citation containing an order of abatement and civil penalties against a person employing or contracting with a person who acts In the capacity of or engages In the business of a respiratory care practitioner in this state without having a license In good standing issued pursuant to this chapter

(Added by Stats 2002 Ch 1150 Sec 34 Effective January 1 2003)

(a) The board shall issue a citation to a person and to his or her employer or contractor if upon Inspection or Investigation either upon complaint or otherwise the following conditions are met (1) The board has probable cause to believe that the person is acting in

the capacity of or engaging In the practice of a respiratory care practitioner In this state without having a license in good standing issued pursuant to this chapter

(2) The person Is not otherwise exempted from the provisions of this chapter

(b) Each citation Issued pursuant to subdivision (a) shall meet all of the following -middot---middot--middot-----reqUirem-ents- middot - middot -- -middotmiddotmiddotmiddot--middot---middot-----middot--middotmiddot middot-middot middot middotmiddot- middot middot-middot ---middot--middotmiddot

(1) Be In writing and describe with particuladty the basis of the citation (2) Contain an order of abatement and an assessment of a civil penalty in

an amount not less than two hundred dollars ($200) nor more than fifteen thousand dollars ($15000)

(c) A person served with a citation may appeal to the board within 15 calendar clays after service of the citation with respect to any of the following (1) Tile violations alleged

3

(2) The scope of the order of abatement (3) The amount of the civil penalty assessed

(d) middot middot If within 15 calendar days after service of the citation the person cited falls to notify the board that he or she Intends to appeal the citation the citation shall be deemed a final order of the board and not subject to review by any court or agency The board may extend the 15-day period for good cause

(e) (1) If a person cited under this section notifies the board In a timely manner that he or she Intends to contest the citation the board shall afford an opportunity for a hearing

(2) The board shall thereaftEr issue a decision based on findings of fact affirming modifying or vacating the citation or directing other appropriate relief

(f) With the approval of the board the executive officer shall prescribe procedures for the issuance and appeal of a citation and procedures for a hearing under this section The board shall adopt regulations covering the assessment of a civil penalty that shall give due consideration to the gravity of the violation and any history of previous violations

(g) middotThe sanctions authorized under this section sl1all be separate from and In addition to any other civil or criminal remedies

(Added by Stats 2002 Ch 1150 Sec 35 Effective Jan11ary 1 2003)

(a) After the exhaustion of the review procedures provided for In Section 3767 and as adopted by regulation the board may apply to the appropriate superior court for both of the following (1) A judgment In the amount of the civil penalty (2) An order compelling the cited person to comply with the order of

abatement

(b) The application described In subdivision (a) shall include a certified copy of the final order of the board

(c) The application described In subdivision (a) shall constitute a sufficient showing to warrant the issuance of the judgment and ordermiddot

middotmiddotmiddot middot middot middotmiddot middotmiddot middot middot middot middot (ar--IITe-lloard may-employcollectlon-agenclesuruther methods-in-ordermiddotto-collect-- middot middot civil penalties

(Added by Stats 2002 Ch 1150 Sec 36 Effective January 1 2003)

37693

4

0 I

(a) Notwithstanding any other provision the board may by stipulation with the affected licensee issue a middotpublic reprimand after it has conducted an Investigation In lieu of filing or prosecuting a formal accusation

(b) The stipulation shall contain the authority grounds and causes and circumstances for taking such action and by way of waiving the affected licensees rights Inform the licensee of his or her rights to have a formal accusation filed and stipulate to a settlement thereafter or have the matter in the statement of Issues heard before an administrative law judge In accordance wltli the Administrative Procedure Act (Chapter 35 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code)

(c) The stipulation shall be public Information and shall be used as evidence in any future disciplinary or penalty action taken by the board

(Amended by Stats 2011 Ch 296 Sec 5 Effective January 1 2012)

5

(including port-a-cath life port) and specifically access with andor remove Huber needledraw bloodconnect and monitor IV fluids (fluid solutions of electrolytes nutrients vitamins blood and blood products) and provide site care (includinq dressinq chanqes) Can perform head to toe physical examinations

A~g enda Item 30 Att h ac ment B (including port-a-cath life port) and specifically access with andor remove Huber needledraw bloodconnect and monitor IV fluids and provide site care (including dressing changes)

Perform head to toe physical assessments

Can reinsert tracheostomy tube in a well-healed tract

Reinsert a tracheostomy tube in an established tract

Can insert feeding tube in a neonate

Insert a feeding tube in a neonate

Remove sheaths in a cardiac cath lab and later dc these lines

An LVN can administer in-line nebulized medication If the ventilator breathing circuit is manipulated simply to establish a port for the medication such manipulation may be done by the LVN If the manipulation in any way changes the parameters of the ventilator delivery the LVN cannot perform such actions

Perform tasks which promote pulmonary health and hygiene (administer oxygen aerosol and IPPB treatments suction perform CPT etc) LPNS MAY NOT HOLD THEMSELVES OUT AS RESPIRATORY THERAPISTS OR RESPIRATORY THERAPY TECHNICIANS

The LVN may change the inner cannula of a tracheostomy during trach care and may disconnect the circuit to do so

The LVN cannot titrate oxygen liter flow to effect The L VN may adjust the flow in accordance with a specific order from the physician

In all cases the LVN must possess the knowledge skill and ability to perform the procedures safely and competently

8IPage 012017

Agenda Item 30Attachment C middot

BUSINESS AND PROFESSIONS CODE - BPC DIVISION 2 HEALING ARTS [500- 4999129]

(Division 2 enacted by Slats 1937 Ch 399) CHAPTER 83 Respiratory Therapy [3700 bull 3779] (Chapter 83 added by Stats 1982 Ch 1344 Sec 1)

ARTICLE 6 Offenses and Enforcement [3760- 37693] (Article 6 added by Stats 1982 Ch I 344 Sec 1 )

3760

(a) Except as otherwise provided in this chapter no person shall engage In the practice of respiratory care respiratory therapy or Inhalation therapy For purposes of this section engaging In the practice of respiratory care Includes but Is not limited to representations by a person whether through verbal claim sign advertisement letterhead business card or other representation that he or she is able to perform any respiratory care service or performance of any respiratory care service

(b) No person who Is unlicensed or whose respiratory care practitioner license has been revoked or suspended or whose license is not valid shall engage in the practice of respiratory care during the period of suspension or revocation even though the person may continue to hold a certificate or registration issued by a private certifying entity

(c) Except as otherwise provided in this chapter no person may represent himself or herself to be a respiratory care practitioner a respiratory therapist a respiratory care technician or an Inhalation therapist or use the abbreviation or letters RCP RP RT or IT or use any modifications or derivatives of those abbreviations or letters without a current and valid license issued under this chapter

(d) No respiratory care practitioner applicant shall begin practice as a respiratorymiddot care practitioner applicant pursLiant to Section 3739 until the applicant meets the applicable requirements of this chapter and obtains a valid work permit

(Amended by Stats 2003 Ch 586 Sec 14 Effective Jan(lary 1 2004)

(a) No person may practice respiratory care or represent himself or herself to be a middotmiddot -~-------resprratolV care prattltloTer-nnnls staremiddot withOm-a-validllcense grarttedlJtder~middot

this chapter except as otherwise provided in this chapter

(b) No person or corporation shall knowingly employ a person who holds himself or herself out to be a respiratory care practitioner without a valid license granted under this chapter except as otherwise provided In this chapter

(Amended by Stats 2003 Ch 586 Sec 15 Effective Jan(lary 1 2004)

1

Notlling in this chapter is Intended to limit preclude or otherwise Interfere with the practices of other llcensed personnel in carrying out authorized and customary duties and functions (Amended by Stats 1994 Ch 1274 Sec 25 Effective January 1 1995)

Jlli

Any person who violates any of the provisions of this chapter shall be guilty of a misdemeanor punisllable by a fine not exceeding one tllousanq dollars ($1000) or Imprisonment In a county jail not exceeding six months or both for each offense (Amended by Stats 1994 Ch 1274 Sec 26 Effective January 1 1995) middot

3764

Whenever any person has engaged or Is about to engage In any acts or practices that constitute or will constitute an offense against tills chapter the superior court of any county on application of the board the Medical Board of Callfornla or by 10 or more persons holding respiratory care practitioner licenses Issued under this chspter msy Issue sn injunction or other appropriate order restrslnlng that conduct Proceedings under this section sllall be governed by Chapter 3 (commencing with Section 525) of Title 7 of Part 2 of the Code of Civil ProcedLire except that no undertaking shall be required in any action commenced by the board (Amended by Stats 1995 Ch 279 Sec 23 Effective January 1 1996)

3765

This act does not prohibit any of the following activities

(a) The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs

(b) Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold himseff or herself out to be a respiratory care practitioner licensed under the provisions of this chapter

(c) The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or specialized training bull

(d) The psufiumancl oLrllipjritory_car~jJJ_an emetgellcY slt~IltJlQDJlYParamegical - _I personnel who have been formally tniined in these modalities and are duly licensed under the provisions of an act pertaining to their specialty

(e) Respiratory care services in case of an emergency Emermiddotgency as used In this subdivision Includes an epidemic or public disaster

(f) Persons from engaging in cardiopulmonary research

2

(g) Formally trained licensees and staff of child day care facilities from administering to a child Inhaled medication as defined in Section 1596798 of the Health and Safety Code

(h) The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the State Department of Public Health of specific limited and basic respiratory care or respiratory care related services that have been authorized by the board

(i) The performance of pulmonary function testing by persons who are currently employed by Los Angeles County hospitals and have performed pulmonary fLinctlon testing for at least 15 years

middot(Amended by Stats 2013 Ch 516 Sec 23 Effective January 1 2014)

(a) The board may issue a citation containing an order of abatement and civil penalties against a person who acts In the capacity of or engages In the business of a respiratory care practitioner In this state without having a license in good standing Issued pursuant to this chapter

(b) The board may Issue a citation containing an order of abatement and civil penalties against a person employing or contracting with a person who acts In the capacity of or engages In the business of a respiratory care practitioner in this state without having a license In good standing issued pursuant to this chapter

(Added by Stats 2002 Ch 1150 Sec 34 Effective January 1 2003)

(a) The board shall issue a citation to a person and to his or her employer or contractor if upon Inspection or Investigation either upon complaint or otherwise the following conditions are met (1) The board has probable cause to believe that the person is acting in

the capacity of or engaging In the practice of a respiratory care practitioner In this state without having a license in good standing issued pursuant to this chapter

(2) The person Is not otherwise exempted from the provisions of this chapter

(b) Each citation Issued pursuant to subdivision (a) shall meet all of the following -middot---middot--middot-----reqUirem-ents- middot - middot -- -middotmiddotmiddotmiddot--middot---middot-----middot--middotmiddot middot-middot middot middotmiddot- middot middot-middot ---middot--middotmiddot

(1) Be In writing and describe with particuladty the basis of the citation (2) Contain an order of abatement and an assessment of a civil penalty in

an amount not less than two hundred dollars ($200) nor more than fifteen thousand dollars ($15000)

(c) A person served with a citation may appeal to the board within 15 calendar clays after service of the citation with respect to any of the following (1) Tile violations alleged

3

(2) The scope of the order of abatement (3) The amount of the civil penalty assessed

(d) middot middot If within 15 calendar days after service of the citation the person cited falls to notify the board that he or she Intends to appeal the citation the citation shall be deemed a final order of the board and not subject to review by any court or agency The board may extend the 15-day period for good cause

(e) (1) If a person cited under this section notifies the board In a timely manner that he or she Intends to contest the citation the board shall afford an opportunity for a hearing

(2) The board shall thereaftEr issue a decision based on findings of fact affirming modifying or vacating the citation or directing other appropriate relief

(f) With the approval of the board the executive officer shall prescribe procedures for the issuance and appeal of a citation and procedures for a hearing under this section The board shall adopt regulations covering the assessment of a civil penalty that shall give due consideration to the gravity of the violation and any history of previous violations

(g) middotThe sanctions authorized under this section sl1all be separate from and In addition to any other civil or criminal remedies

(Added by Stats 2002 Ch 1150 Sec 35 Effective Jan11ary 1 2003)

(a) After the exhaustion of the review procedures provided for In Section 3767 and as adopted by regulation the board may apply to the appropriate superior court for both of the following (1) A judgment In the amount of the civil penalty (2) An order compelling the cited person to comply with the order of

abatement

(b) The application described In subdivision (a) shall include a certified copy of the final order of the board

(c) The application described In subdivision (a) shall constitute a sufficient showing to warrant the issuance of the judgment and ordermiddot

middotmiddotmiddot middot middot middotmiddot middotmiddot middot middot middot middot (ar--IITe-lloard may-employcollectlon-agenclesuruther methods-in-ordermiddotto-collect-- middot middot civil penalties

(Added by Stats 2002 Ch 1150 Sec 36 Effective January 1 2003)

37693

4

0 I

(a) Notwithstanding any other provision the board may by stipulation with the affected licensee issue a middotpublic reprimand after it has conducted an Investigation In lieu of filing or prosecuting a formal accusation

(b) The stipulation shall contain the authority grounds and causes and circumstances for taking such action and by way of waiving the affected licensees rights Inform the licensee of his or her rights to have a formal accusation filed and stipulate to a settlement thereafter or have the matter in the statement of Issues heard before an administrative law judge In accordance wltli the Administrative Procedure Act (Chapter 35 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code)

(c) The stipulation shall be public Information and shall be used as evidence in any future disciplinary or penalty action taken by the board

(Amended by Stats 2011 Ch 296 Sec 5 Effective January 1 2012)

5

Agenda Item 30Attachment C middot

BUSINESS AND PROFESSIONS CODE - BPC DIVISION 2 HEALING ARTS [500- 4999129]

(Division 2 enacted by Slats 1937 Ch 399) CHAPTER 83 Respiratory Therapy [3700 bull 3779] (Chapter 83 added by Stats 1982 Ch 1344 Sec 1)

ARTICLE 6 Offenses and Enforcement [3760- 37693] (Article 6 added by Stats 1982 Ch I 344 Sec 1 )

3760

(a) Except as otherwise provided in this chapter no person shall engage In the practice of respiratory care respiratory therapy or Inhalation therapy For purposes of this section engaging In the practice of respiratory care Includes but Is not limited to representations by a person whether through verbal claim sign advertisement letterhead business card or other representation that he or she is able to perform any respiratory care service or performance of any respiratory care service

(b) No person who Is unlicensed or whose respiratory care practitioner license has been revoked or suspended or whose license is not valid shall engage in the practice of respiratory care during the period of suspension or revocation even though the person may continue to hold a certificate or registration issued by a private certifying entity

(c) Except as otherwise provided in this chapter no person may represent himself or herself to be a respiratory care practitioner a respiratory therapist a respiratory care technician or an Inhalation therapist or use the abbreviation or letters RCP RP RT or IT or use any modifications or derivatives of those abbreviations or letters without a current and valid license issued under this chapter

(d) No respiratory care practitioner applicant shall begin practice as a respiratorymiddot care practitioner applicant pursLiant to Section 3739 until the applicant meets the applicable requirements of this chapter and obtains a valid work permit

(Amended by Stats 2003 Ch 586 Sec 14 Effective Jan(lary 1 2004)

(a) No person may practice respiratory care or represent himself or herself to be a middotmiddot -~-------resprratolV care prattltloTer-nnnls staremiddot withOm-a-validllcense grarttedlJtder~middot

this chapter except as otherwise provided in this chapter

(b) No person or corporation shall knowingly employ a person who holds himself or herself out to be a respiratory care practitioner without a valid license granted under this chapter except as otherwise provided In this chapter

(Amended by Stats 2003 Ch 586 Sec 15 Effective Jan(lary 1 2004)

1

Notlling in this chapter is Intended to limit preclude or otherwise Interfere with the practices of other llcensed personnel in carrying out authorized and customary duties and functions (Amended by Stats 1994 Ch 1274 Sec 25 Effective January 1 1995)

Jlli

Any person who violates any of the provisions of this chapter shall be guilty of a misdemeanor punisllable by a fine not exceeding one tllousanq dollars ($1000) or Imprisonment In a county jail not exceeding six months or both for each offense (Amended by Stats 1994 Ch 1274 Sec 26 Effective January 1 1995) middot

3764

Whenever any person has engaged or Is about to engage In any acts or practices that constitute or will constitute an offense against tills chapter the superior court of any county on application of the board the Medical Board of Callfornla or by 10 or more persons holding respiratory care practitioner licenses Issued under this chspter msy Issue sn injunction or other appropriate order restrslnlng that conduct Proceedings under this section sllall be governed by Chapter 3 (commencing with Section 525) of Title 7 of Part 2 of the Code of Civil ProcedLire except that no undertaking shall be required in any action commenced by the board (Amended by Stats 1995 Ch 279 Sec 23 Effective January 1 1996)

3765

This act does not prohibit any of the following activities

(a) The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs

(b) Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold himseff or herself out to be a respiratory care practitioner licensed under the provisions of this chapter

(c) The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or specialized training bull

(d) The psufiumancl oLrllipjritory_car~jJJ_an emetgellcY slt~IltJlQDJlYParamegical - _I personnel who have been formally tniined in these modalities and are duly licensed under the provisions of an act pertaining to their specialty

(e) Respiratory care services in case of an emergency Emermiddotgency as used In this subdivision Includes an epidemic or public disaster

(f) Persons from engaging in cardiopulmonary research

2

(g) Formally trained licensees and staff of child day care facilities from administering to a child Inhaled medication as defined in Section 1596798 of the Health and Safety Code

(h) The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the State Department of Public Health of specific limited and basic respiratory care or respiratory care related services that have been authorized by the board

(i) The performance of pulmonary function testing by persons who are currently employed by Los Angeles County hospitals and have performed pulmonary fLinctlon testing for at least 15 years

middot(Amended by Stats 2013 Ch 516 Sec 23 Effective January 1 2014)

(a) The board may issue a citation containing an order of abatement and civil penalties against a person who acts In the capacity of or engages In the business of a respiratory care practitioner In this state without having a license in good standing Issued pursuant to this chapter

(b) The board may Issue a citation containing an order of abatement and civil penalties against a person employing or contracting with a person who acts In the capacity of or engages In the business of a respiratory care practitioner in this state without having a license In good standing issued pursuant to this chapter

(Added by Stats 2002 Ch 1150 Sec 34 Effective January 1 2003)

(a) The board shall issue a citation to a person and to his or her employer or contractor if upon Inspection or Investigation either upon complaint or otherwise the following conditions are met (1) The board has probable cause to believe that the person is acting in

the capacity of or engaging In the practice of a respiratory care practitioner In this state without having a license in good standing issued pursuant to this chapter

(2) The person Is not otherwise exempted from the provisions of this chapter

(b) Each citation Issued pursuant to subdivision (a) shall meet all of the following -middot---middot--middot-----reqUirem-ents- middot - middot -- -middotmiddotmiddotmiddot--middot---middot-----middot--middotmiddot middot-middot middot middotmiddot- middot middot-middot ---middot--middotmiddot

(1) Be In writing and describe with particuladty the basis of the citation (2) Contain an order of abatement and an assessment of a civil penalty in

an amount not less than two hundred dollars ($200) nor more than fifteen thousand dollars ($15000)

(c) A person served with a citation may appeal to the board within 15 calendar clays after service of the citation with respect to any of the following (1) Tile violations alleged

3

(2) The scope of the order of abatement (3) The amount of the civil penalty assessed

(d) middot middot If within 15 calendar days after service of the citation the person cited falls to notify the board that he or she Intends to appeal the citation the citation shall be deemed a final order of the board and not subject to review by any court or agency The board may extend the 15-day period for good cause

(e) (1) If a person cited under this section notifies the board In a timely manner that he or she Intends to contest the citation the board shall afford an opportunity for a hearing

(2) The board shall thereaftEr issue a decision based on findings of fact affirming modifying or vacating the citation or directing other appropriate relief

(f) With the approval of the board the executive officer shall prescribe procedures for the issuance and appeal of a citation and procedures for a hearing under this section The board shall adopt regulations covering the assessment of a civil penalty that shall give due consideration to the gravity of the violation and any history of previous violations

(g) middotThe sanctions authorized under this section sl1all be separate from and In addition to any other civil or criminal remedies

(Added by Stats 2002 Ch 1150 Sec 35 Effective Jan11ary 1 2003)

(a) After the exhaustion of the review procedures provided for In Section 3767 and as adopted by regulation the board may apply to the appropriate superior court for both of the following (1) A judgment In the amount of the civil penalty (2) An order compelling the cited person to comply with the order of

abatement

(b) The application described In subdivision (a) shall include a certified copy of the final order of the board

(c) The application described In subdivision (a) shall constitute a sufficient showing to warrant the issuance of the judgment and ordermiddot

middotmiddotmiddot middot middot middotmiddot middotmiddot middot middot middot middot (ar--IITe-lloard may-employcollectlon-agenclesuruther methods-in-ordermiddotto-collect-- middot middot civil penalties

(Added by Stats 2002 Ch 1150 Sec 36 Effective January 1 2003)

37693

4

0 I

(a) Notwithstanding any other provision the board may by stipulation with the affected licensee issue a middotpublic reprimand after it has conducted an Investigation In lieu of filing or prosecuting a formal accusation

(b) The stipulation shall contain the authority grounds and causes and circumstances for taking such action and by way of waiving the affected licensees rights Inform the licensee of his or her rights to have a formal accusation filed and stipulate to a settlement thereafter or have the matter in the statement of Issues heard before an administrative law judge In accordance wltli the Administrative Procedure Act (Chapter 35 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code)

(c) The stipulation shall be public Information and shall be used as evidence in any future disciplinary or penalty action taken by the board

(Amended by Stats 2011 Ch 296 Sec 5 Effective January 1 2012)

5

Notlling in this chapter is Intended to limit preclude or otherwise Interfere with the practices of other llcensed personnel in carrying out authorized and customary duties and functions (Amended by Stats 1994 Ch 1274 Sec 25 Effective January 1 1995)

Jlli

Any person who violates any of the provisions of this chapter shall be guilty of a misdemeanor punisllable by a fine not exceeding one tllousanq dollars ($1000) or Imprisonment In a county jail not exceeding six months or both for each offense (Amended by Stats 1994 Ch 1274 Sec 26 Effective January 1 1995) middot

3764

Whenever any person has engaged or Is about to engage In any acts or practices that constitute or will constitute an offense against tills chapter the superior court of any county on application of the board the Medical Board of Callfornla or by 10 or more persons holding respiratory care practitioner licenses Issued under this chspter msy Issue sn injunction or other appropriate order restrslnlng that conduct Proceedings under this section sllall be governed by Chapter 3 (commencing with Section 525) of Title 7 of Part 2 of the Code of Civil ProcedLire except that no undertaking shall be required in any action commenced by the board (Amended by Stats 1995 Ch 279 Sec 23 Effective January 1 1996)

3765

This act does not prohibit any of the following activities

(a) The performance of respiratory care that is an integral part of the program of study by students enrolled in approved respiratory therapy training programs

(b) Self-care by the patient or the gratuitous care by a friend or member of the family who does not represent or hold himseff or herself out to be a respiratory care practitioner licensed under the provisions of this chapter

(c) The respiratory care practitioner from performing advances in the art and techniques of respiratory care learned through formal or specialized training bull

(d) The psufiumancl oLrllipjritory_car~jJJ_an emetgellcY slt~IltJlQDJlYParamegical - _I personnel who have been formally tniined in these modalities and are duly licensed under the provisions of an act pertaining to their specialty

(e) Respiratory care services in case of an emergency Emermiddotgency as used In this subdivision Includes an epidemic or public disaster

(f) Persons from engaging in cardiopulmonary research

2

(g) Formally trained licensees and staff of child day care facilities from administering to a child Inhaled medication as defined in Section 1596798 of the Health and Safety Code

(h) The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the State Department of Public Health of specific limited and basic respiratory care or respiratory care related services that have been authorized by the board

(i) The performance of pulmonary function testing by persons who are currently employed by Los Angeles County hospitals and have performed pulmonary fLinctlon testing for at least 15 years

middot(Amended by Stats 2013 Ch 516 Sec 23 Effective January 1 2014)

(a) The board may issue a citation containing an order of abatement and civil penalties against a person who acts In the capacity of or engages In the business of a respiratory care practitioner In this state without having a license in good standing Issued pursuant to this chapter

(b) The board may Issue a citation containing an order of abatement and civil penalties against a person employing or contracting with a person who acts In the capacity of or engages In the business of a respiratory care practitioner in this state without having a license In good standing issued pursuant to this chapter

(Added by Stats 2002 Ch 1150 Sec 34 Effective January 1 2003)

(a) The board shall issue a citation to a person and to his or her employer or contractor if upon Inspection or Investigation either upon complaint or otherwise the following conditions are met (1) The board has probable cause to believe that the person is acting in

the capacity of or engaging In the practice of a respiratory care practitioner In this state without having a license in good standing issued pursuant to this chapter

(2) The person Is not otherwise exempted from the provisions of this chapter

(b) Each citation Issued pursuant to subdivision (a) shall meet all of the following -middot---middot--middot-----reqUirem-ents- middot - middot -- -middotmiddotmiddotmiddot--middot---middot-----middot--middotmiddot middot-middot middot middotmiddot- middot middot-middot ---middot--middotmiddot

(1) Be In writing and describe with particuladty the basis of the citation (2) Contain an order of abatement and an assessment of a civil penalty in

an amount not less than two hundred dollars ($200) nor more than fifteen thousand dollars ($15000)

(c) A person served with a citation may appeal to the board within 15 calendar clays after service of the citation with respect to any of the following (1) Tile violations alleged

3

(2) The scope of the order of abatement (3) The amount of the civil penalty assessed

(d) middot middot If within 15 calendar days after service of the citation the person cited falls to notify the board that he or she Intends to appeal the citation the citation shall be deemed a final order of the board and not subject to review by any court or agency The board may extend the 15-day period for good cause

(e) (1) If a person cited under this section notifies the board In a timely manner that he or she Intends to contest the citation the board shall afford an opportunity for a hearing

(2) The board shall thereaftEr issue a decision based on findings of fact affirming modifying or vacating the citation or directing other appropriate relief

(f) With the approval of the board the executive officer shall prescribe procedures for the issuance and appeal of a citation and procedures for a hearing under this section The board shall adopt regulations covering the assessment of a civil penalty that shall give due consideration to the gravity of the violation and any history of previous violations

(g) middotThe sanctions authorized under this section sl1all be separate from and In addition to any other civil or criminal remedies

(Added by Stats 2002 Ch 1150 Sec 35 Effective Jan11ary 1 2003)

(a) After the exhaustion of the review procedures provided for In Section 3767 and as adopted by regulation the board may apply to the appropriate superior court for both of the following (1) A judgment In the amount of the civil penalty (2) An order compelling the cited person to comply with the order of

abatement

(b) The application described In subdivision (a) shall include a certified copy of the final order of the board

(c) The application described In subdivision (a) shall constitute a sufficient showing to warrant the issuance of the judgment and ordermiddot

middotmiddotmiddot middot middot middotmiddot middotmiddot middot middot middot middot (ar--IITe-lloard may-employcollectlon-agenclesuruther methods-in-ordermiddotto-collect-- middot middot civil penalties

(Added by Stats 2002 Ch 1150 Sec 36 Effective January 1 2003)

37693

4

0 I

(a) Notwithstanding any other provision the board may by stipulation with the affected licensee issue a middotpublic reprimand after it has conducted an Investigation In lieu of filing or prosecuting a formal accusation

(b) The stipulation shall contain the authority grounds and causes and circumstances for taking such action and by way of waiving the affected licensees rights Inform the licensee of his or her rights to have a formal accusation filed and stipulate to a settlement thereafter or have the matter in the statement of Issues heard before an administrative law judge In accordance wltli the Administrative Procedure Act (Chapter 35 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code)

(c) The stipulation shall be public Information and shall be used as evidence in any future disciplinary or penalty action taken by the board

(Amended by Stats 2011 Ch 296 Sec 5 Effective January 1 2012)

5

(g) Formally trained licensees and staff of child day care facilities from administering to a child Inhaled medication as defined in Section 1596798 of the Health and Safety Code

(h) The performance by a person employed by a home medical device retail facility or by a home health agency licensed by the State Department of Public Health of specific limited and basic respiratory care or respiratory care related services that have been authorized by the board

(i) The performance of pulmonary function testing by persons who are currently employed by Los Angeles County hospitals and have performed pulmonary fLinctlon testing for at least 15 years

middot(Amended by Stats 2013 Ch 516 Sec 23 Effective January 1 2014)

(a) The board may issue a citation containing an order of abatement and civil penalties against a person who acts In the capacity of or engages In the business of a respiratory care practitioner In this state without having a license in good standing Issued pursuant to this chapter

(b) The board may Issue a citation containing an order of abatement and civil penalties against a person employing or contracting with a person who acts In the capacity of or engages In the business of a respiratory care practitioner in this state without having a license In good standing issued pursuant to this chapter

(Added by Stats 2002 Ch 1150 Sec 34 Effective January 1 2003)

(a) The board shall issue a citation to a person and to his or her employer or contractor if upon Inspection or Investigation either upon complaint or otherwise the following conditions are met (1) The board has probable cause to believe that the person is acting in

the capacity of or engaging In the practice of a respiratory care practitioner In this state without having a license in good standing issued pursuant to this chapter

(2) The person Is not otherwise exempted from the provisions of this chapter

(b) Each citation Issued pursuant to subdivision (a) shall meet all of the following -middot---middot--middot-----reqUirem-ents- middot - middot -- -middotmiddotmiddotmiddot--middot---middot-----middot--middotmiddot middot-middot middot middotmiddot- middot middot-middot ---middot--middotmiddot

(1) Be In writing and describe with particuladty the basis of the citation (2) Contain an order of abatement and an assessment of a civil penalty in

an amount not less than two hundred dollars ($200) nor more than fifteen thousand dollars ($15000)

(c) A person served with a citation may appeal to the board within 15 calendar clays after service of the citation with respect to any of the following (1) Tile violations alleged

3

(2) The scope of the order of abatement (3) The amount of the civil penalty assessed

(d) middot middot If within 15 calendar days after service of the citation the person cited falls to notify the board that he or she Intends to appeal the citation the citation shall be deemed a final order of the board and not subject to review by any court or agency The board may extend the 15-day period for good cause

(e) (1) If a person cited under this section notifies the board In a timely manner that he or she Intends to contest the citation the board shall afford an opportunity for a hearing

(2) The board shall thereaftEr issue a decision based on findings of fact affirming modifying or vacating the citation or directing other appropriate relief

(f) With the approval of the board the executive officer shall prescribe procedures for the issuance and appeal of a citation and procedures for a hearing under this section The board shall adopt regulations covering the assessment of a civil penalty that shall give due consideration to the gravity of the violation and any history of previous violations

(g) middotThe sanctions authorized under this section sl1all be separate from and In addition to any other civil or criminal remedies

(Added by Stats 2002 Ch 1150 Sec 35 Effective Jan11ary 1 2003)

(a) After the exhaustion of the review procedures provided for In Section 3767 and as adopted by regulation the board may apply to the appropriate superior court for both of the following (1) A judgment In the amount of the civil penalty (2) An order compelling the cited person to comply with the order of

abatement

(b) The application described In subdivision (a) shall include a certified copy of the final order of the board

(c) The application described In subdivision (a) shall constitute a sufficient showing to warrant the issuance of the judgment and ordermiddot

middotmiddotmiddot middot middot middotmiddot middotmiddot middot middot middot middot (ar--IITe-lloard may-employcollectlon-agenclesuruther methods-in-ordermiddotto-collect-- middot middot civil penalties

(Added by Stats 2002 Ch 1150 Sec 36 Effective January 1 2003)

37693

4

0 I

(a) Notwithstanding any other provision the board may by stipulation with the affected licensee issue a middotpublic reprimand after it has conducted an Investigation In lieu of filing or prosecuting a formal accusation

(b) The stipulation shall contain the authority grounds and causes and circumstances for taking such action and by way of waiving the affected licensees rights Inform the licensee of his or her rights to have a formal accusation filed and stipulate to a settlement thereafter or have the matter in the statement of Issues heard before an administrative law judge In accordance wltli the Administrative Procedure Act (Chapter 35 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code)

(c) The stipulation shall be public Information and shall be used as evidence in any future disciplinary or penalty action taken by the board

(Amended by Stats 2011 Ch 296 Sec 5 Effective January 1 2012)

5

(2) The scope of the order of abatement (3) The amount of the civil penalty assessed

(d) middot middot If within 15 calendar days after service of the citation the person cited falls to notify the board that he or she Intends to appeal the citation the citation shall be deemed a final order of the board and not subject to review by any court or agency The board may extend the 15-day period for good cause

(e) (1) If a person cited under this section notifies the board In a timely manner that he or she Intends to contest the citation the board shall afford an opportunity for a hearing

(2) The board shall thereaftEr issue a decision based on findings of fact affirming modifying or vacating the citation or directing other appropriate relief

(f) With the approval of the board the executive officer shall prescribe procedures for the issuance and appeal of a citation and procedures for a hearing under this section The board shall adopt regulations covering the assessment of a civil penalty that shall give due consideration to the gravity of the violation and any history of previous violations

(g) middotThe sanctions authorized under this section sl1all be separate from and In addition to any other civil or criminal remedies

(Added by Stats 2002 Ch 1150 Sec 35 Effective Jan11ary 1 2003)

(a) After the exhaustion of the review procedures provided for In Section 3767 and as adopted by regulation the board may apply to the appropriate superior court for both of the following (1) A judgment In the amount of the civil penalty (2) An order compelling the cited person to comply with the order of

abatement

(b) The application described In subdivision (a) shall include a certified copy of the final order of the board

(c) The application described In subdivision (a) shall constitute a sufficient showing to warrant the issuance of the judgment and ordermiddot

middotmiddotmiddot middot middot middotmiddot middotmiddot middot middot middot middot (ar--IITe-lloard may-employcollectlon-agenclesuruther methods-in-ordermiddotto-collect-- middot middot civil penalties

(Added by Stats 2002 Ch 1150 Sec 36 Effective January 1 2003)

37693

4

0 I

(a) Notwithstanding any other provision the board may by stipulation with the affected licensee issue a middotpublic reprimand after it has conducted an Investigation In lieu of filing or prosecuting a formal accusation

(b) The stipulation shall contain the authority grounds and causes and circumstances for taking such action and by way of waiving the affected licensees rights Inform the licensee of his or her rights to have a formal accusation filed and stipulate to a settlement thereafter or have the matter in the statement of Issues heard before an administrative law judge In accordance wltli the Administrative Procedure Act (Chapter 35 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code)

(c) The stipulation shall be public Information and shall be used as evidence in any future disciplinary or penalty action taken by the board

(Amended by Stats 2011 Ch 296 Sec 5 Effective January 1 2012)

5

0 I

(a) Notwithstanding any other provision the board may by stipulation with the affected licensee issue a middotpublic reprimand after it has conducted an Investigation In lieu of filing or prosecuting a formal accusation

(b) The stipulation shall contain the authority grounds and causes and circumstances for taking such action and by way of waiving the affected licensees rights Inform the licensee of his or her rights to have a formal accusation filed and stipulate to a settlement thereafter or have the matter in the statement of Issues heard before an administrative law judge In accordance wltli the Administrative Procedure Act (Chapter 35 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code)

(c) The stipulation shall be public Information and shall be used as evidence in any future disciplinary or penalty action taken by the board

(Amended by Stats 2011 Ch 296 Sec 5 Effective January 1 2012)

5