June 24, 2004 Board Meeting Minutes

BOARD MEETING
PUBLIC SESSION MINUTES

June 24, 2004

Holiday Inn
1355 North Harbor Drive
San Diego, CA 92101
9:45 AM - 2:30 PM

CALL TO ORDER
(Scott J. Svonkin, President)

The Public Session meeting was called to order at 9:40 a.m. by President Svonkin. A quorum was present.

APPROVAL OF NOVEMBER 14, 2003 PUBLIC SESSION MINUTES

Dr. Sheldon moved to approve the November 14, 2003 Public Session Minutes as written.

M/Sheldon/S/Stenson
Unanimous: Renner, Salinger, Sheldon, Stenson, Stern, Svonkin
MOTION PASSED

EXECUTIVE OFFICER'S REPORT
(Stephanie Nunez, Executive Officer)
Profession Request: Licensure Examination

Ms. Nunez noted the first agenda item (3A) was a request received from the California Society for Respiratory Care (CSRC) that the Board consider or change the entry-level examination from the CRT to the RRT.

Mr. Renner stated he thought the National Board for Respiratory Care (NBRC) would not allow us to use the RRT exam as our licensing exam.

Ms. Debra Volpe, from the audience, commented it was her understanding that the CSRC would be presenting this to the Board. It was noted that the letter stated the Board of Directors had unanimously voted on this proposal, yet no representation from the CSRC was present. Ms. Volpe advised the Board that at the American Association for Respiratory Care (AARC) Summer Forum, there were several comments about standards of practice and entry level. She stated as far as establishing minimum competency level, California wanted to be the first to establish an advance practitioner status as being their State's licensure requirement. She noted it was of interest because of the problem that the NBRC is currently having of getting everyone credentialed at that higher status [a requirement by the Committee on Accreditation for Respiratory Care who accredits respiratory care education programs].

Vice President Salinger stated that she thought this proposal would have a large impact on the Board and on its general state and is something that needs to be investigated and discussed further.

President Svonkin joined the meeting at 10:20 A.M.

Mr. Renner noted it might be beneficial to find out how many CRTs and RRTs there are in California to determine the impact.

Ms. Nunez advised that in speaking with the NBRC, they noted that the CRT examination is examining entry-level work in the field. The CRT examination, as Gary Smith (the director of the NBRC) stated, will not go away. It will always be the entry-level examination and "entry-level practice" not "education" drives the entry-level examination.

Mr. Stern stated that his review of the letter simply states the resolution that was passed by the CSRC was to make the RRT exam the only exam one can take if one wishes to be a respiratory care practitioner in California. He noted that he gathered the exam is proprietary to the NBRC, so unless they say that it can be used by any State, California cannot make such a change. He added that the first step would be to address the NBRC and ask them if they have an interest in changing their policy.

Ms. Nunez advised that she had spoken with the NBRC and that they are not supportive of allowing their RRT exam be used as a licensing exam. She noted they also made this clear a few years ago and had stated the NBRC will never allow the RRT exam to be used as the licensing examination.

Ms. Nunez advised that the item would be raised during the next strategic planning session for discussion between interested parties. Publication of Disciplinary Actions

Ms. Nunez advised the Board that some respiratory therapists have made suggestions to remove "disciplinary actions" from the Board's newsletters and use an alternative means to make this information available. Discussion ensued.

No action to change the existing publication of disciplinary actions was taken.

General Report

Ms. Nunez advised the Board that the Technical Amendments & Education Changes regulation package went into effect May 22nd.

Ms. Nunez noted that she had attended a meeting with the Office of Information Services (OIS) who provides database, computer, and internet support to the Board. She stated that credit card acceptance seems to be a very high priority among many of the boards, though the OIS stated it did not currently have the resources for this project. She feels enough boards requesting this made it one of the OIS's top five priorities.

Ms. Nunez commented on the status of the California Performance Review. She advised that Governor Schwarzenegger had used over 200 employees and other individuals on a team to conduct a review of State Government. The ultimate goal is to restructure, reorganize and reform State Government.

Ms. Nunez noted that the co-director of the review stated he expected the report to contain recommendations to eliminate or consolidate some of the State boards, commissions and agencies. The co-director noted that there are about 300 boards and 2500 appointees and he estimated that half of those boards would be eliminated. He stated they want to implement new technologies and processes and reduce the State workforce mainly through attrition. The co-director stated it could take 2-3 years to implement.

Ms. Nunez stated that it was reported that some of the recommendations could be realized immediately; some would go to the Little Hoover Commission (to which, Mr. Mitchell, a past Board member, is part of now) and some would require legislation.

President Svonkin noted that he believed the Legislature would still have to agree to the elimination of any boards. Mr. Ritter confirmed that if they plan a Governor's reorganization, the Legislature could veto it if they choose to do so. President Svonkin added, it's a political reality that while Governor Schwarzenegger is excited about this right now (being new to office), he may change his mind as he runs for re-election in two years.

Ms. Nunez advised the Board of the Department's new director, Charlene Zettel, former Assemblywoman from the San Diego area. She also advised of the new Chief Deputy Director, Sherry Mehl. Ms. Nunez stated she was especially pleased with the appointment of the new Chief Deputy Director as she is a former Executive Officer, a real go-getter and she understands the issues that boards encounter.

Ms. Nunez stated that in a recent meeting with the Director and Chief Deputy Director, it was noted that the Department's complaint disclosure would be revised and they would be taking a harder look at cite and fine programs, fee increases, new studies or advisory groups, or requests for increases in staff. It was noted that the hiring freeze was expected to be lifted July 1. Additionally, the Department is making a concentrated effort to fill vacant Governor appointments.

Dr. Sheldon noted that the fact that there are proposals to shrink the number of licensing boards suggests the unlikely chances of establishing a new board for professions such as polysomnography or pulmonary function testing.

PROFESSIONAL LICENSING COMMITTEE REPORT
(Larry L. Renner, RCP, Chair, Richard L. Sheldon, M.D., Member)
Polysomnography, Pulmonary Function Testing, Hyperbaric Oxygen Therapy, and Cardiac Catheterization Personnel

Mr. Renner advised that Dr. Sheldon and he are looking at pulmonary function testing, polysomnograph testing and hyperbaric oxygen therapy and their work is progressing. He noted that in the agenda materials, there is a pulmonary function testing survey. He stated that the intent is really to gather additional information as we have continued to do along the way, so that we can make an informed decision about how to move this process forward.

Dr. Sheldon summarized highlights from a meeting he attended with the American Association for Respiratory Care, Board of Medical Advisors (BOMA): a group of about twenty physicians from across the United States who are the end users of respiratory care services representing the American College of Anesthesiology, American Thoracic Society, and the ACCP. He stated the discussion was very professional and thorough with well over 50% of the conversation on the issue of licensing technologists in the field of sleep and the growing interests across the United States that there be some kind of a regulatory system set up for polysomnography. Dr. Epstein, the president of the American Academy of Sleep Medicine, invited to make a presentation at this meeting, requested that there not be a licensing process set up for polysomnography technologist at this point and time. Dr Sheldon added, the position of the AARC and BOMA was that eventually there has to be some kind of licensing system. Dr. Sheldon further explained that the NBRC is working on two new exams. One, to obtain special credentialing in critical care and discussions are taking place for another in polysomnography. He advised the Board of a motion unanimously passed at this meeting that BOMA proceed, through the NBRC, to establish a career track with a credentialing exam in polysomnography. Dr. Sheldon added that the big argument of whether or not all polysomnography technologists need to be respiratory therapists has ended. BOMA's final vote was in support of the eventual regulatory systems for the field of polysomnography technology and that this would move ahead in some kind of advancement with the American Academy of Sleep Medicine at their direction. Dr. Sheldon warned there might be differing opinions as to what constitutes the appropriate speed to implement such a regulatory system but we have to take into account that there has to be a system that guarantees patient protection and the consumer affairs issues need to be looked into carefully.

President Svonkin asked if the Board needed to take any particular action or if Board members have recommendations on this issue.

Ms. Nunez responded that the Board is not at a point where it can make recommendations but rather is working towards developing those recommendations. She noted that the Board is sending out surveys to interested parties to gather information and feedback.

Ms. Nunez stated a major issue is the California Thoracic Society's opposition to any type of regulation for polysomnography or pulmonary function testing. She explained that Dr. Sheldon has been very successful so far in getting these other national organizations to look at this issue.

President Svonkin stated the opposition is not an issue if alternative suggestions are offered as well.

Home Care

Mr. Renner reported he was pleased that Ms. Nunez has been meeting with the Department of Health Services and believes we were heading in the right direction.

Ms. Nunez reported that she and staff have been meeting with the Home Medical Device Retail Facilities section of the Department of Health Services (DHS). She explained DHS is a huge department, with many sections. To improve communication among all interested parties, in May, regular meetings with the Children Services Branch for MediCal, the Home Medical Device Retail Facilities section, and MediCal Reimbursement Division commenced. Ms. Nunez stated they have had two meetings so far and plan to continue. It seems like every one involved is energized and excited about getting on the same path and eliminating problems. Ms. Nunez explained that some were not even aware RCPs provided home care and on that issue she has been invited to offer input to MediCal Reimbursement for provider standards.

Ms. Nunez stated it was brought to her attention that the California Thoracic Society distributed some pediatric home ventilator guidelines. Those guidelines failed to mention that an RCP is the person that should be providing the care and educating parents. They do however mention RNs and LVNs.

President Svonkin asked if the guidelines were final.

Ms. Nunez stated, yes (in their opinion) but a lot of other organizations might want to have input on this (especially the RCB) and hopes the Board would give some authority (make a motion) for Dr. Sheldon and Mr. Renner to address this.

President Svonkin stated he thought it would be appropriate to have a motion and at least communicate through a letter.

Dr. Sheldon moved that the California Respiratory Care Board initiate a response in the form of a letter back to the California Thoracic Society asking for clarification why respiratory therapists were not mentioned in these guidelines.

Mr. Stern seconded the motion.

President Svonkin suggested an amendment that any other communications, meetings, etc. be included in that motion and that they communicate, to every one who received the guidelines, the RCB's letter of concern about RCPs not being listed in the appropriate place.

Mr. Stern stated that he included President Svonkin's additional suggestions as part of the motion.

Unanimous: Renner, Salinger, Sheldon, Stenson, Stern, Svonkin

MOTION PASSED

Michael Gibbons, CSRC, commented that the CSRC and the CTS would be working together to make basic statements about the issues of polysomnography and pulmonary function testing.

THE BOARD AND RCP PROFESSIONALS - DVD PRESENTATION BY LARRY L. RENNER, RCP, MEMBER

Mr. Renner noted that this was a project started about 2- 3 years ago and that the intent was to point out what a respiratory therapist does in kind of a first hand production to the profession and to enhance communication. He stated the main purpose of this presentation was to get comments from the Board and audience.

The DVD presentation was well received and numerous accolades were given to Mr. Renner.

EDUCATION COMMITTEE REPORT
(Barbara M. Stenson, RCP, Chair, Kim Cooper Salinger MBA, RRT, Member)

Law and Professional Ethics Course

Ms. Stenson reported there was a delay in implementation of the Law and Professional Ethics course due to some language problems with legislation.

Vice President Salinger noted that originally, implementation for this course for all RCPs was to occur at the beginning of 2005. She added the delay will be beneficial in allowing more time to develop a better product.

Ms. Nunez commented that the delay would probably extend the implementation of the course by at least one year.

Student Work Permit/Background Checks

Vice President Salinger reported that the Board has received some calls about facilities requiring background checks on students as a result of JCAHO's new requirements. The idea of obtaining background checks prior to a student beginning his/her clinical rotation is an item that we have on the agenda for our strategic planning session for further discussion.

President Svonkin stated he attended a CSRC Board meeting where it was suggested the RCB look into the issue of a provisional license. He asked Ms. Stenson and Ms. Cooper to research this and be prepared to share information and ideas at a future board meeting.

Section 3735.5: Exam Equivalency

Vice President Salinger explained that under current Board requirements, a person who hasn't practiced for quite some time, who hasn't maintained licensure or practiced in another state can suddenly come in, reapply for licensure and go out into practice (even after being out of the field for many years). Vice President Salinger explained that the Committee is proposing the attached language which will require someone who has been out of the field for 5 years or who has not maintained licensure in a state that requires licensure for at least 1 year in the past 5 to re-sit the CRT exam. She explained within 5 years the respiratory field experiences a complete change in technology and practices.

Ms. Molina added when someone applies for licensure from another state and has taken and passed the NBRC, CRT examination, the RCB does not require they re-sit for the examination. They merely need verification of their credential provided. She explained that staff has encountered situations where someone may have completed a JCRTE program in the 70's or early 80's, have an Associate degree (even if in another discipline) and with that, they meet the education requirements. And if they've past a version of the CRT examination (even if it was in 1985) and they've yet to practice, they essentially meet the minimum requirements to be issued a license to practice.

Ms. Nunez provided that this regulatory language will require applicants to have passed the exam or have 1 year of active practice within the last five years or have passed the exam after 2002 (when the NBRC instituted re-credentialing tied with continuing education).

Dr. Sheldon noted the five-year requirement and stated that the NBRC announced at the BOMA meeting that they will be instituting a policy that if you don't sit through your exam after graduating within 36 months, you will have to reapply and there will be sanctions. They want to get rid of this board eligible level within the new graduates.Dr. Sheldon inquired whether, in order to clear up confusion, if it should be every 3 years instead of 5 years for uniformity.

Dr. Sheldon moved to approve the policy presented with the change from 5 to 3 years wherever the five appears.

Mr. Stern seconded.

M/Sheldon/S/Stern
Unanimous: Renner, Salinger, Sheldon, Stenson, Stern, Svonkin
MOTION PASSED

FEES: STATE COMPARISON AND DISCUSSION REGARDING POLICY FOR REDUCTION IN FUTURE YEARS BASED ON BUDGET/RESERVES
(Kim Cooper Salinger, MBA, RRT, Vice-President)

Vice President Salinger opened this item by noting that because the California Respiratory Care Board has the highest licensure fees for respiratory care in the country they decided to try and figure out why; what was the difference between the way we do things here compared to various states? She stated the biggest factor found was the way government runs in the State of California, which is completely different from the way it runs in any other states. There are so many mandatory fees built into requirements, fees that cannot be avoided driving up the cost when compared to other states. She added we are a small division within this huge government structure and are obviously not going to be able to change the entire government structure. Vice President Salinger stated in light of the discussion of eliminating and consolidating some boards, they would like to put this project on hold to await the outcome all of those transitions.

President Svonkin stated that should the Board hit a projected reserve requiring, by law, either a refund or reduction of fees, he would like to create a Board policy that reduces fees instead of issuing a refund, which would be costly.

Ms. Nunez noted that the Board's expenditures continue to exceed its revenues and with higher rates charged to the Board, this gap may widen. She added it is unlikely the Board will exceed its six-month reserve anytime in the near future.

Mr. Stern inquired how the cost passed along to the practitioner compared to other states. For example: Division of Investigation (Did you find that other place don't have to pay Division of Investigation) or probation monitoring (Did you find that other places don't have the same expenditure for that)?

Ms. Nunez explained 3 states were compared. The closest information was from West Virginia: who charges $130 (if it were paid in two years); we charge $230. They have 1100 licensees; we have 15,000. They have 36 complaints in a year; we have 602 (and 32 of their 36 complaints are for CE violation, which require no AG). Their legal fees are $1,200, ours are in the range of $300,000. Ms. Nunez continued, the RCB pays about $400,000 in pro-rata that we are required to pay to the government for services that we may or may not use. West Virginia does not have that. Some of the boards in other states combined with other boards using the same services. Ms. Nunez added California agencies do not work together. If there is a problem with a facility or an RCP in a facility, multiple DHS units go out to investigate as well as the Respiratory Care Board. While other states do their own reports, we have to use the Attorney General without option.

President Svonkin suggested spreading the fees over a period of time for new licensees. A working RCP has an easier time paying the fees than a new licensee coming straight out of school.

Ms. Nunez agreed that from the standpoint of revenue, the application fee is a lesser source than the thousands of renewal fees received each year. Ms. Nunez stated the latest accommodation the Board made (in that line of thinking) was instead of doing an initial licensure fee at a flat rate; we reduced the amount of time to 6 to 18 months and prorated it. That was a significant reduction in the fee. She added that a year ago the Board announced if any more reductions in fees were to happen it would be to the renewal fee.

Mr. Renner suggested information be put together to determine the overall impact of the budget and funds if applicant fees were reduced.

Ms. Stenson suggested that the projections include different fees from those applying from out-of-state.

Ms. Nunez affirmed that projections for the next meeting would be made available to the Board for consideration of reducing applicant fees.

EXECUTIVE COMMITTEE REPORT
(Scott J. Svonkin, President, Kim Cooper Salinger, MBA, RRT, Vice-President)

Strategic Goals and Objectives

President Svonkin noted that all Board members received a copy of the strategic goals and objectives and that it continues to be updated.

The status of each goal was reviewed. Discussion ensued.

Mr. Stern complimented that having been involved in a number of strategic plans, he has never seen such close attention paid to following up and making sure actions were taken.

President Svonkin added that he thought staff was doing a great job.

Presentation to Eugene "Mitch" Mitchell

President Svonkin: "Recently, we had a very sad opening on our Board; we received a letter of resignation. I think it was not by choice. I think it was by request of our new Governor. I don't always agree with our new governor, many people won't be surprised to hear that, but I knew that he was going to take one of the most dedicated, smartest members from us. I had a feeling, knew it was going to happen and unfortunately, it did. Our loss is the Little Hoover Commission's gain. Mitch has served loyally on this board since 1999 when he was appointed by then Governor Wilson. He must have known what an incredibly bright man and dedicated public servant Mitch was, so he asked him to serve on this board as a public member. When I joined the Board, I was helped along the way as a public member on how to approach things and how to look at things. I'm going to be forever grateful and miss him personally. Because his counsel and advice, particularly to me, as a public member, was invaluable and I am personally very grateful. Then the last governor was very wise, and he reappointed Mitch in 2002. And the newest Governor was smart too and appointed him to the Little Hoover Commission. For those of you who don't know about the Little Hoover Commission, they are a body empowered to basically look at problems in the State and find solutions. It's a great place for him to be because that's how he approaches things. He is one of the consummate problem solvers in California. The Chamber is lucky to have him here. Chambers across the State would be lucky to have someone with his talent. He served as Vice President in 2000 and 2001. The first meeting he attended was January 22, 1999. I want to give each of the Board members a chance to share any thoughts or comments and also staff."

Mr. Stern: "I'm just grateful for having a chance to know Eugene Mitchell. I'm going to miss him. I wish you well. The State's going to do well with you."

Mr. Renner: "I would just reiterate what Gary already said and what you said also that Mitch brought very good insight to the Board and kind of kept us on task when we went astray. He will be missed by us but we will keep in contact."

Dr. Sheldon: "Even though you and I had our disagreements. Once again, I want to apologize for calling you at 4:30 in the morning (6 month old baby on board) Nonetheless, best of luck to you and congratulations. I remember reading about the formation of Little Hoover Commission in college (as a history major). I know you realize I'm that old ... (laughter)... and how impressed I am with your appointment to that commission. Congratulations."

Mr. Mitchell: "Thank you very much. Thank you I really appreciate that."

Ms. Stenson: "I just want to say that I really have enjoyed working with you. You're a very committed and dedicated person."

Vice President Salinger: "I agree. It's a great thing to have you on the Commission."

Ms. Nunez: "I wrote a few things down: I know that staff has the same perception of you (because we talk about you ... (laughter) It was his very first meeting, he's handed an agenda book and right there, he caught on just like that! You are so intelligent. With every issue, you grasp the concepts, you understand and you go with it. You've always been very kind, you're friendly, you're welcoming and you're very approachable. You're very fair. You're a good mediator. You seriously evaluate other's opinions and you take that input (not a lot of people do that). You always conduct yourself with integrity and I really admire that. You don't compromise your beliefs. I am going to miss you as a Board member but as a California citizen, I am so proud that the Governor selected you to be on the Commission and represent us. We're in good hands."

Mr. Mitchell: Thank you very much.

President Svonkin: "Not only on behalf of the Board, but on behalf of the people of California, Mitch, I want to present you with this": In recognition and appreciation for your years of leadership as a member of the Respiratory Care Board and for your loyalty to consumer protection and the advancement of the respiratory care profession, we're presenting you with a plaque for your service. There isn't any body that cares more about the jobs he does than this man. He's the busiest, most active person I've ever met. I've learned a great deal. For that I'm very grateful and the people of California are grateful because your input at every meeting was substantive and thoughtful. I sometimes talk too much and Mitch got us going in the right direction and taught me how to be a better board member and a better person and made us focus on the right things at our meetings. We're going to miss you."

Mr. Mitchell: "Thank you. I am honored and moved by the comments. I remember my very first meeting. I was getting into something that I wasn't really sure what it was but I was up for the challenge. I remember talking about the strategic plan and about the needs of respiratory care. And I took a real interest in it because it was a situation that was an unknown to me. I work in Sacramento. I get paid to look at issues, at problem and I've always challenged myself to try and find solutions. This has been a great learning experience. I know so much more about the work and the industry and I have so much more respect for the industry because of the knowledge that I've gained here. Dr. Sheldon mentioned that we didn't always agree. The best thing about this is that you should learn from every experience you have and Dr. Sheldon and I had some moments when we were on opposite sides of the fence but we managed to find middle ground and that's really how you achieve progress. I think what often stops things from moving forward is that inability to find middle ground. Scott and I often talked about the need to try and find that balance. You're not always going to make everybody happy all the time but trying to get to middle, ultimately you're going to make more people happy. A lot of my interaction with you was a great learning experience. The Staff: You guys were always great. I run around all over and you never hesitated to call me, chase me down, find out where I was. Christine, you and I had some great conversations. What I think overall is that we are lucky as an entity because you get to that point where you get people who are at the top and who really don't care (it's about getting a check) That's not what you guys do. You were all dedicated. I would say this about that group that runs the entity, they're all dedicated. I always appreciated that. You always listened to me. Even if you may have had an opinion coming in, you were always one to say, okay, I'll see that side of it and how we make this work. Again, I'm looking forward to my new challenge with the Little Hoover. I can tell you that I've already set my sights on the next big thing that we have to fix (and it is a big thing) But I think that what we have to do is fix the State. It's going to make life a lot easier for everybody that lives here and that includes all of you. I live here in San Diego. I'm proud to live here. You mentioned parking is a problem; you ought to see housing, transportation, electricity, and water. We live at the bottom of the State and we call this paradise but this is a very difficult paradise to live in at times. That's what gets me out of bed every day. You guys will still see me (especially you guys). I'm in Sacramento a lot especially these days. Please, everybody just remember: always learn something from every experience. Keep striving and keep up the good work. For you guys, hey, thank you very much. I really appreciated it."

Sunset Review Recommendations

Ms. Nunez reviewed the Sunset Review Recommendations and noted that recommendation #2 [Unlicensed Personnel/Home Care] is the only recommendation left for completion.

Budget/Revenue Reports

President Svonkin turned this item over to Ms. Nunez. Ms. Nunez noted that the Attorney General fees have gone up. They went up from $112 to $132 an hour effective April 1, 2004. The Paralegal fees (which we use for most of our legal services) went from $53 to $91 an hour (a 72% increase). The attorney fees are going up to $139 ($7 more on July 1st). She added some of our practice cases are a little bit more complex (taking a few more hours). Ms Nunez continued, the OAH fees for hearings also went up. We only have about 20 hearings a year but the hourly fee for the ALJ has gone up from $161 to $169/hr. Ms Nunez explained that our Attorney General line item was actually augmented by the department for all boards and bureaus. Fortunately, the method they used worked to our advantage only increasing it $48,000. We're hoping that with cite and fine (processing more cases in-house) we'll even out with these fee increases.

Disciplinary Self Assessment on Web

President Svonkin requested the Boards input on whether a self-assessment should be added to the website so that potential students can identify if they have any issues that might prevent them from becoming a licensed practitioner.

Mr. Ritter stated the fundamental problem in that is each case must be dealt with on a case specific basis and evaluating all the factors involved. If there was this generic response, that could be a problem.

Mr. Renner suggested as opposed to providing it as a self-assessment, maybe just list the most frequent reasons why a license would be denied and this could be updated as information changes. He added a disclaimer can be included stating that each case is treated individually and if they need additional information they can contact a staff member.

ENFORCEMENT COMMITTEE REPORT
(Vacant, Chair, Gary N. Mr. Stern, Esq., Member)

Enforcement Statistics

Mr. Stern reviewed the Enforcement Statistics comparing current stats with FY 02/03.

Unlicensed Personnel Regulations

Mr. Stern stated the Board had moved forward to establish a Cite and Fine policy with regulations for unlicensed personnel, which was to take effect in July. He explained, earlier this month Board staff was informed that the Department of Consumer Affairs was not going to be able to approve or support any cite and fine regulations or legislation. The perception from the new administration may be that cite and fine appears to be a method to generate revenue only (because no other penalty is imposed other than cite and fine). That concept has been raised in years past on this Board. He added, it appears, however, that the staff people from the administration are open to learning about what cite and fine programs really do. Probably the most significant point that we want to bring to them by way of education is the benefit of establishing a documented history and then of course public disclosure. The thought is that once the administration learns about the benefits of this form of discipline, it will approve future legislation and regulatory language addressing that legislation. Mr. Stern added our Professional Licensing Committee is heading up two of the highest priorities that we are dealing with on the Board (specifically the reform of regulation of home care and the research of unlicensed personnel practicing in area such as pulmonary function testing and polysomnography) which may actually alleviate or at least modify the need to implement cite and fine as applied to unlicensed personnel. Those reports will be submitted to the Joint Legislative Sunset Review Committee next year at which time discussion to pursue the citation and fine program against unlicensed personnel should be revisited.

LEGISLATIVE/LEGAL AFFAIRS COMMITTEE REPORT
(Vacant, Chair, Scott J. President Svonkin, Member)

2004 Proposed Legislation

President Svonkin stated that he, Mr. Mitchell and Ms. Nunez had worked for many months on a package of legislation, which this Board approved and submitted. However, a staff member in the committee that was carrying the legislation for us left and went to the administration. After being informed none of the legislation was going to be carried, Ms. Nunez began negotiating with them. The outcome was that 5 out of the 13 items were allowed to be included in the legislation and the others will have to go to next year (if the Board chooses).

Mr. Stern asked which five are going forward.

Ms. Nunez listed: 3702.5 [Sedation], 3702.7 [Mechanical and Physiological Ventilatory Support], 3719.5 [CE] which was modified to the broader language listed, 3750.5 [Additional Grounds for Denial, Suspension or Revocation] that was clearly just a technical change and 3769.3 [Licensee - Public Letter of Reprimand] - A public letter of reprimand which allows an in-house process to issue a letter of public.

*** CLOSED SESSION ***

The Board convened into Closed Session at 1:15, as authorized by Government Code section 11126(c)(3) and reconvene into open session at approximately 1:30 PM.

RCP RECOGNITION: MS. GLORIA "JEAN" LeBLANC, SCRIPPS MEMORIAL HOSPITAL, LA JOLLA
(Barbara M. Stenson, RCP)

Ms. Stenson presented Ms. Gloria "Jean" LeBlanc with a plaque in recognition of the values of service, dignity, responsibility, teamwork, trust, accountability and relativity to the Board's mission as an RCP.

President Svonkin thanked Ms. LeBlanc, her family, and colleagues for coming to join the Board during the presentation. He stated that this is one of the special times in our Board meetings when we get to recognize the professionals that make a difference in the lives of Californians. He added, from his understanding, she not only makes the lives of her patients better but every body that works with her thinks the world of her and that is a real testament to her work as an RCP.

BOARD BADGE/IDENTIFICATION
(Scott J. President Svonkin, President)

President Svonkin stated there was a question about how Board members can identify themselves. He added every Board member is allowed to have business cards. He suggested every Board member (who would like one) be given a Consumer Affairs I.D. (example handed out). So that when you represent the Board in an event, you can identify yourself.

Dr. Sheldon moved to request a photograph ID card.

Mr. Stern seconded the motion.

M/Sheldon/S/Stern
Unanimous: Renner, Salinger, Sheldon, Stenson, Stern, Svonkin
MOTION PASSED

PUBLIC COMMENT ON ITEMS NOT ON THE AGENDA

Colleen Richardson, Executive Director of the California Thoracic Society noted that the CTS established a new program for respiratory therapy scholarships with funds from the CTS. She noted that the scholarship application is available on their website and their goal is to try to encourage people to enter the profession and turn around the work force shortage.

Ms. Richardson also noted that dialogue was opened between the CTS and the Board with Ms. Nunez's attendance at CTS's March meeting regarding unlicensed personnel in the practices of polysomnography and pulmonary function testing. She stated the concern seemed to be the security of patients, especially in the home. The CTS members there pointed out that licensure is not the best way to deal with that. There are risks to people from a newspaper deliverer to the bottle water deliverer and everything else. We certainly believe competent people should be providing quality care and doing it well but licensure can be a barrier when there is already a shortage.

Ms. Richardson noted that the pediatric guidelines that were mentioned earlier were a two-year project and there was a pediatric respiratory therapist that was on the committee that originated the concept. It was sent out to 14 programs around the State that do pediatric home ventilator care and discharge into the community. The people and the personnel that they are dealing with are the resources that are out there. She added she's sure they'd be happy to review and comment on anything about how that can be made even better.

There were no other comments.

FUTURE AGENDA ITEMS

President Svonkin stated he would like to get a sense of how much it would cost and how we could coordinate with the DAG?s office for a home health care sting.

Dr. Sheldon requested the matter be discussed in closed session.

RESCHEDULING OF OCTOBER 14th & 15th BOARD MEETING AND/OR STRATEGIC PLANNING SESSION
(Scott J. President Svonkin, President)

The Board rescheduled its next meeting to December 13, 2004. The strategic planning session will be scheduled at the next board meeting in conjunction with the first scheduled meeting of 2005.

President Svonkin requested Legal Counsel to report at the next meeting; if possible, the meeting regulations so that he and any future chair [president] can make appropriate rulings.

ADJOURNMENT

Dr. Sheldon moved to adjourn.

M/Sheldon/S/Renner
Unanimous: Renner, Salinger, Sheldon, Stenson, Stern, Svonkin
MOTION PASSED