May 16th, 2003 Board Meeting Minutes

BOARD MEETING
PUBLIC SESSION MINUTES

May 16 , 2003

Department of Consumer Affairs
400 R Street, 1st Floor Hearing Room
Sacramento, CA 95814

1. CALL TO ORDER
(Scott Svonkin, President)

The Public Session meeting was called to order at 10:00 a.m. by President Svonkin. A quorum was present.

2. HEARING: REQUEST FOR REINSTATEMENT, CHRIS SAVEDRA

President Svonkin announced that Mr. Chris Savedra had withdrawn his request for the hearing.

4. APPROVAL OF NOVEMBER 8, 2002 PUBLIC SESSION MINUTES

Mr. Chaturvedi moved to approve the November 8, 2002 Public Session Minutes.

M/Chaturvedi/S/Stern
Unanimous: Chaturvedi, Mitchell, Renner, Stenson, Stern, Svonkin, Winn
MOTION PASSED

5. CALIFORNIA CODE OF REGULATIONS SECTIONS 1399.301 - 1399.395 RE: TECHNICAL AMENDMENTS AND EDUCATION - BOARD DISCUSSION/VOTE

Ms. Nunez presented the final proposed language and comments received. Dr. Winn moved to adopt the language as presented.

M/Winn/S/Renner Unanimous:
Chaturvedi, Mitchell, Renner, Stenson, Stern, Svonkin, Winn
MOTION PASSED

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

Ms. Stenson stated there was nothing to report at this time.

7. PRESENTATION TO BARRY WINN, Ed.D., RCP

Scott J. Svonkin, President: Although I've only been President since January, I feel very fortunate to be able to head up this effort to recognize our longest serving member. In public service it's rare that you find people that are so dedicated and are willing to give of their time and energy for little to no return. And Barry is one of those incredible people that has given of himself to his profession and this Board in ways that will probably never be measured but we're going to try to recognize them today.

He welcomed me to the Board as he has most of these folks and he made the board meetings enjoyable and allowed for everybody to participate from the minute they arrived.

Dr. Winn has been a professor at Grossmont College since 1975. He was originally appointed to the Respiratory Care Board in 1990 and subsequently reappointed to two terms in 94 and 98. Since his appointment he has served in a number of capacities. He's been the longest serving President in the history of this Board. I wouldn't be surprised if its one of the longest serving presidents in the history of any DCA board. And that kind of leadership is remarkable in a day when its hard to get people to help out and give of their time.

So, I'm fortunate enough to have served just a short time with Dr. Winn, but I want to allow all the Board members to recognize him. His expertise in the field has been recognized and in a number of organizations in a number of ways. But the things that he has accomplished that will forever mark our Board have been his leadership in the Sunset Review process, his participation in the Enforcement and Licensing Committees, his leadership in education regulations, scope of practice, student clinical areas, and his, as late as today, his eagerness to fight the good fight to protect the profession and scope of practice. Before the meeting started he bent my ear and wanted to make sure that as President that I fought to keep those out of the professions that aren't qualified to practice and to make sure that patients have licensed RCPs in their homes when they need one.

And so I commit to you Barry to try to accomplish 1 centimeter of what you accomplished. I'm honored to sit on the same Board with you. On behalf of all of us and in a few minutes, on behalf of the Legislature, Governor and the State of California I want to thank you for your contributions and your years of service. I want to let all the Board members speak, but first I'm going ask Stephanie to talk. And at the very end of the presentation I'm going to ask Barry to join me up here to make a little presentation.

Stephanie Nunez, Executive Officer: Well Barry I met you about 10 years ago at a Board meeting. I knew from the time I met you what a very genuine and very kind human being you were. You always supported us, me and the staff, both professionally and personally. You've been an absolute pleasure to work for and with. You've done a lot for this board; making contributions by improving our operations and communications with our stakeholders. And I am mostly proud of you for your commitment. Since you've been appointed you've been committed to consumer protection and raising the standards of your profession. And I as well as all of our staff are truly going to miss you very much. And we've also brought back somebody you know very well, Cathleen McCoy who was the previous Executive Officer for over ten years is here today to say goodbye to Barry.

Ms. Nunez asked Cathleen if she had anything she wanted to say. President Svonkin stated he would be happy to turn the meeting over to her if she would like to say a few words.

Cathleen A. McCoy (previous Executive Officer): I just want to thank Barry because when I came here in 1990 from New Jersey, Barry came on board a few months after I came on so he helped me with my learning curve on what respiratory care was about, how it is a profession and how astronomically it is expanding and the duties that respiratory care practitioners could do. He helped me many times at the Legislature to fight the fight for the profession, especially blood gases and how that it is not limited to only blood gas analysis and how RCPs are more than trained. He gave me the textbooks to take to the Legislature to show there was no such thing as blood gas 101 which at the time was a bill that they were trying to pass through. Personally, he is the best boss that I've ever had in my life. He has always made you strive to be more professionally than you are. Even if when you might have met the mark of something that you are doing, he can show you where you could improve on so the next time your could surpass that mark. And I can't thank you enough and I miss you terribly. I'm sorry to see you leave the Board but I think the Board has been a better place because of you.

Larry Renner, Vice-President: I've only had the opportunity to work with Barry since about 2000. I guess the first thing I want to say is that medical professions as a whole don't move forward without people. Regardless of disagreements or agreements that people have had with the Board in the past, I think that where the respiratory care profession has gone is because of people like Barry. And particularly Barry and his dedication to the profession and making it better because of that. I really appreciated the opportunity to get to know him personally. I have heard many things about him prior to coming on this board ... they were all good Barry (laughter).... Your presence on the Board will definitely be missed.

Eugene Mitchell: Barry you were instrumental in a lot of things that has happened to me in my tenure on the Board. But I'll always remember when you took over as president, the last time. You said that there was no problem too big to be resolved. And if you remember, we were going through some pretty big problems. Your spirit was kind of a factor that we would resolve everything and get things back in order. I always thought the best times to see Barry are in his actual work environment. He's wearing his white jacket walking around the halls with a big smile on his face like he could stay there all day. And that is truly it. If you've never seen him in that environment it's something everyone should see. I've seen him two or three times and he always has a smile. And that's what everybody will always remember Barry by.

Gary Stern, Esq.: It looks like I'm the senior board member here except for Barry (laughter). I've had the privilege of being on the Board with Barry since 1997. As a public member, my experience in the past with licensing boards, the Medical Board and two others, was the notion that those individuals who served on such boards who are part of those professions, might have a tendency to protect the profession at the expense of consumers. And when I came on this Board, it took me about ½ of one meeting to realize that Barry Winn was on this board as a respiratory care practitioner to serve the consumers of California while at the same time recognizing the dignity and the professionalism of his profession. It is a marvelous balance to achieve and it was obvious that he had achieved it some time before he came on the board. His ability to engage you in a discussion on something where there might be significant differences of opinion, and yet to reach a consensus or to strive for a consensus is a rare ability indeed Barry. It has been an astute privilege to know you and work with you on this Board. And on behalf of the people that have been on the Board in the past and have spent some time with you over the years on this Board, thank you.

Gopal Chaturvedi: I've known Barry for the past two years. I see the way he helps the Board and his dedication. Ask anybody, you did a marvelous job. I saw the way you conducted yourself and board meetings; very nice. One thing I know is that your legacy is that you want to take this home care all the way. And I believe this Board understands very clearly and I think we will follow it all the way. So Barry you started the endeavor and I hope we will finish the job. Thank you.

Barbara Stenson: I've known Barry for maybe ten years. And his students have been working through my hospital. I think you have shown your commitment you have to the profession and the education ofstudents. And I hope you keep that going with your students. You've done a very nice job. It has been a pleasure to work with you on the Board and I hope we work together in the future.

President Svonkin [presenting Barry with a plaque and Senate Rules resolution]: Barry this is just a small thanks on behalf of the State and the people of California. Most people that are treated by a respiratory therapist won't know. I'm fortunate enough to have been treated by respiratory therapists and now know one that is out there making sure the profession focused on not just consumers but the people they take care of. And I think this is the least we can do and I hope you continue to work with us and help us stay focused on the things that are important.

Dr. Winn thanked everyone for their kind words and recognition. "I'm really the one that is honored because when I started on the RCB, California was really in its infancy and I think that Cate and I struggled through a battle or two. It was eventful. We've done a lot of things. One of the things that is neat about this Board we all had a common focus and we've overcame some major hurdles. And I am really proud of where we are at now. I think that Cate did a fantastic job. Steph picked up, she hit the ground running, I think she's done a fantastic job. Crissy has been right there. The whole staff, you can't ask for a better staff that serves us. I am amazed we are so lucky to have the staff that we have. And I love you all."

8. EXECUTIVE OFFICER'S REPORT
(Stephanie Nunez, Executive Officer)

A. Employee Recognition

Ms. Nunez presented staff members Jennifer Mercado and Paula Velasquez with plaques for their contributions and achievements that have moved the Board forward in meeting its Strategic Plan's Goals and Objectives.

Ms. Mercado enthusiastically travels to attend various career fairs throughout California. In addition to attending the career fairs, she also visits various high schools throughout California and informs the students of the respiratory care profession and its advantages.

Ms. Velasquez was instrumental in creating the Board's automated billing program. Since the creation of this database, staff processing time has been reduced by 85%. In addition, Ms. Velasquez's contribution has potentially saved the Board up to $10,000, the cost if the Board had been forced to contract with an outside vendor.

B. FY 03/04 Budget

Ms. Nunez informed the Board that over the past six months, staff has been requested to perform budget drills, reduce in-state travel by 35%, and eliminate out of state travel. Ms. Nunez added that in April, the Department of Finance requested a Personal Services Reduction and Layoff Plan that includes 10% reductions in personnel items generally consisting of salaries and benefits. The most significant reductions that were included in our plan was the layoff of two employees and a reduction in the amount of per-diem available for board members. Ms. Nunez added that she, Ms. Zimmerman and Ms. Molina will also be taking a 5% salary cut effective July 1st.

Mr. Mitchell asked why we would be affected since the RCB is a special fund Board. Ms. Nunez explained that no differential is being shown between special funded and general funded agencies.

Vice-President Renner asked when a decision would be made regarding the cuts. Ms. Nunez responded that it could be around July or August, and is expected to directly correlate with the passing of the budget. Mr. Mitchell added that he thought an agreement would need to be reached soon, as it relates to the union and pay reductions.

9. EXECUTIVE COMMITTEE REPORT
(Scott J. Svonkin, President, Larry L. Renner, RCP, Vice-President)

A. Strategic Goals and Objectives

Ms. Nunez briefly reviewed the Board's strategic goals and objectives.

As it relates to Professional Licensing Goal #1 and home care, Dr. Winn suggested a Public Service Announcement (PSA) that provides an 800 number for the public.

While reviewing Enforcement Goal #1, "Enforcing the Respiratory Care Practice Act against persons unlicensed and unqualified to practice respiratory care," President Svonkin stated, that we need to publicize actions taken by the Board. Ms. Nunez asked if we could add President Svonkin's suggestion and Dr. Winn's suggestion, regarding the 800 number to this goal. Mr. Mitchell added that we should be able to get a PSA on cable channels for free if coordinated properly. Mr. Mitchell suggested that we get the PSA produced for free at universities or colleges. Dr. Winn noted that Grossmont College has a TV station that may be able to assist in the production. Mr. Mitchell also noted that CoxCommunication may also be able to assist.

President Svonkin directed staff to include these suggestions in the implementation plan rather than modifying the goal.

Ms. Nunez reported that the final regulations to implement the revisions to the disciplinary guidelines and enforcement policies (Enforcement Goal #2) were filed with the Secretary of State and will be effective May 21st.

Ms. Nunez reported that in line with Enforcement Goal #3, a new law allowed RCPs, on probation, for specific violations, to petition the Board for termination of probation during the 2003 calendar year. Since that law was effective, the Board has received 53 petitions to terminate probation and has granted 46 of those petitions. Ms. Nunez compared the Board's costs to operate the probation program in 2001 and 2003 at $290,000 and $165,000, respectively. She noted that the Board has not filled behind vacated positions and transferred staff to other Board programs where needed.

Dr. Winn asked the Board if in the future we should consider looking at licensing or registering Durable Medical Companies (DMEs) for the purposes of regulation and tracking. President Svonkin suggested that the Board consider requiring manufactures who create new technology to gain Board approval. Dr. Winn noted that the Food and Drug Administration currently reviews and approves new technology. Mr. Mitchell noted that he is not in favor of requiring Board approval for new technology because it could prevent new technology from being developed if weighted down by additional fees. President Svonkin noted Dr. Winn's suggestion and recommended that the idea of possibly licensing or registering DMEs be considered at a strategic plan review in the future.

In relation to Outreach Goal #1, President Svonkin stated the feedback that he's gotten from meeting with and talking to program directors since people found out he was elected President has been incredible. The positive feelings about him helping them provide information to get them recruits for the program has been phenomenal.

President Svonkin noted that he has, identified about 40 television shows and gotten the names and phone numbers of the head writer in order to pitch incorporation of the profession in the shows. President Svonkin stated that he has gotten through about half of the list, made contacts, sent letters, and then attempted to set up meetings for him, a licensed RCP and maybe one other person.

President Svonkin also stated he has been trying to identify universities that can help, identify a credible number so that the Board can tell people that for over the next 5 years California needs 30,000 RCPs to meet the needs of the aging population in California so that we can focus on specific results.

President Svonkin suggested all elected officials be added to the Board's publications mailing list. Mr. Mitchell suggested publications be mailed to the career-to-work components in the State.

As it relates to Outreach Goal #3, President Svonkin noted that we have had one conference call each with the CSRC and the AARC this year and that the plan is to have these conference calls at least twice a year. He stated that he hoped following the meeting, he could schedule a meeting on some of the important issues with DCA. President Svonkin stated he's already been in touch with the Governor's office on some of the Board's major initiatives just to keep them apprized of the kind of things that are going on so they don't forget the Board as a player. President Svonkin added that this is a critical step in the maturity of this Board to have that kind of give and take with everybody we work with.

President Svonkin inquired as to when the data received from the Satisfaction Surveys becomes statistically valid. Ms. Nunez replied that it is not necessary to make the responses statistically valid because the data is for the Board's information and may be shared with the Legislature.

B. Sunset Review Recommendations - Status

Ms. Nunez provided a summary of the Sunset Review recommendations and advised that the Board is still working on recommendation number two as it relates to home care and number three continuing to refine our enforcement processes. Ms. Nunez entertained questions from the Board.

C. Committee Assignments

President Svonkin thought it would be best for him not to chair committees while serving as the Board's President, but will participate as a member. Therefore, the Outreach Program will be chaired by Mr. Chaturvedi and the Legislative Affairs Committee being chaired by Mr. Mitchell.

President Svonkin stated that he specifically asked Gopal to chair the Outreach to take advantage of e-government initiatives within DCA and maximize them.

President Svonkin noted that the Professional Licensing Committee will also be responsible for identifying and monitoring areas being practiced by unlicensed personnel and that Larry and Dr. Sheldon will hopefully come back with suggestions and recommendations on how we can be more aggressive on going after unlicensed personnel.

President Svonkin stated he wanted to get a sense from the Board if they are amenable to having a committee review and present a plan to spend a chunk of money, whether it be $50,000 or $60,000, to create a program either regionally, on campuses or with hospitals as partners to increase recruiting efforts. Hearing no objections, President Svonkin directed the Education Committee to continue working on this issue.

D. Budget Reports

Ms. Nunez entertained questions from the Board regarding the budget reports. Mr. Mitchell noted that we had exceeded our printing budget. Ms. Nunez explained that this year we have printed laws and regulations, career pamphlets, newsletters, and applications which are generally not all done in one year. Ms. Nunez explained in response to Mr. Mitchell's inquiry that the additional monies used for printing were planned to be compensated for from other budget line items where savings were projected.

E. November Meeting Location

President Svonkin explained that he would like to relocate the November 14, 2003 board meeting from San Diego to Sacramento due to the current budget crisis the state is currently experiencing.

Mr. Mitchell moved that the Board relocate the November 14, 2003 meeting from San Diego to Sacramento.

M/Mitchell/S/Chaturvedi
Unanimous: Chaturvedi, Mitchell, Renner, Stenson, Stern, Svonkin, Winn
MOTION PASSED

F. Ethics Training

President Svonkin stated that the Board should mandate a Continuing Education (CE) ethics training course related to the respiratory care profession for respiratory care practitioners (RCPs), thus reducing the number of enforcement cases.

M/Winn/S/Chaturvedi

Discussion ensued.

Dr. Winn stated that you will not be ethical by virtue of taking a course. Dr. Winn noted that ethics is taught by your parent(s) growing up and it is a life long thing. Dr. Winn added that he thought an ethics course would reinforce what has already been learned. Dr. Winn stated that he would be in favor of it if there were a pilot course for CE because teaching values is never wrong.

In response to Mr. Mitchell's request, President Svonkin confirmed the course would be mandatory and would be part of the required continuing education. Mr. Mitchell asked where the cost of $60 - $90 was derived. Ms. Nunez advised the information before the board was prepared by the American Association for Respiratory Care (AARC) as a general idea to be further developed.

Mr. Stern inquired what the price range is for other continuing education courses taken. Ms. Stenson advised that the price range varies. She stated that some people don't have to pay anything for a course taken at the hospital. Ms. Stenson expressed her concern that the cost would be a hardship to respiratory therapists. Mr. Mitchell and Mr. Stern agreed. Ms. Stenson stated the highest cost for a 1-hour course is generally $30 but that many therapists obtain free continuing education through their employer. Mr. Mitchell expressed concern with the amount that would be charged to attend the CE course.

Mr. Chaturvedi noted that the costs for the course could ultimately reduce enforcement costs which may then possibly reduce the renewal fee. President Svonkin suggested that staff create a course and place a ceiling on the maximum amount that could be charged for the training.

Dr. Winn stated he liked the idea. He stated to consider not requiring the course every renewal period. He also suggested talking with the AARC to inquire about allowing the Board to have the course available on the Board's website and video tape for a lesser fee.

Mr. Stern moved to amend the motion to authorize staff to research and consult with the various stake holders and further develop the proposal for a mandatory ethics course in a cost-effective manner and all of the issues related (i.e timing, etc...) and report back to the Board at the November board meeting.

M/Stern/S/Winn

Mr. Stern clarified that it was not to mandate a course but to gather information about mandating an ethics course. Dr. Winn withdrew his motion.

Ms. Scuri informed the Board that this would need to go through legislation prior to it being mandated.

Mr. Stern stated that probably having an optional ethics course available on the internet would be sufficient. Mr. Stern stated based on his experience he does not accept the assumption that mandating an ethics course brings the benefit that one would hope for.

Unanimous: Chaturvedi, Mitchell, Renner, Stenson, Stern, Svonkin, Winn
MOTION PASSED

President Svonkin asked if there was willingness on the part of the Board to entertain a motion to submit language to the Legislature that would allow mandating an ethics course in whatever form the board chooses after developing it.

M/Mitchell/S/Stern

Vice-President Renner stated that putting the language in before we actually do research is premature.

In response to Mr. Stern's inquiry, Dr. Winn, Ms. Stenson and Vice-President Renner expressed that they support the idea of making an ethics course available but are opposed to mandating a course especially one where costs are associated.

President Svonkin called for a vote.

Ayes: Chaturvedi, Mitchell, Svonkin
Nos: Renner, Stenson, Stern, Winn
MOTION FAILS

Vice-President Renner requested literature or documentation from more than one reference supporting that an ethics course will improve consumer protection.

President Svonkin stated he thought consumers are crying out for some sort of help on this issue and that he thought it is appropriate public policy to do the best to empower the practitioners to protect themselves and the public.

Vice-President Renner stated that he did not disagree but that in the acute care hospital there are plenty of programs that address ethics and he thought we need to be prudent to make sure we are not setting up something that doesn't go above and beyond what's already being provided.

President Svonkin stated we will bring more information to the Board in November and find a way to adopt an ethics course process that all board members can support.

G. Recognition of RCPs in Armed Forces

President Svonkin stated that there were a number of RCPs who are or have served in Iraq and would like to recognize their accomplishments.

M/Mitchell/S/Winn
Unanimous: Chaturvedi, Mitchell, Renner, Stenson, Stern, Svonkin, Winn
MOTION PASSED

President Svonkin added that the recipient would be presented with a certificate or plaque and would be recognized in the Board's newsletter. President Svonkin requested that the public contact the Board with any nominations for this award.

10. ENFORCEMENT COMMITTEE REPORT
(Eugene W. Mitchell, Chair, Gary N. Stern, Esq., Member)

A. Enforcement Statistics

Mr. Mitchell noted that the number of complaints received was a little higher. Ms. Zimmerman noted that the Board has received additional mandatory reporting and rap sheet types of complaints.

B. Cite and Fine Regulations: Applicant Impact

Ms. Nunez stated this item was placed on the agenda at the request of Mr. Stern who had concerns with cite and fining an applicant. Ms. Scuri clarified that the issuance of a citation and fine would be done simultaneously with the issuance of a license and would be done only through stipulation.

C. Proposed Regulatory Language: Unlicensed Personnel / Employer

Ms. Nunez presented proposed language for regulations to implement sections 3766, 3767 and 3768, citation and fine of unlicensed personnel.

Mr. Stern moved to move forward with the language as presented in the regulatory process.

M/Stern/S/ Mitchell
Unanimous:
MOTION PASSED

11. OUTREACH COMMITTEE REPORT
(Gopal D. Chaturvedi, Chair, Scott J. Svonkin, Member)

A. RCP Recruitment

Item discussed under 9-C Committee Assignments.

B. RCP Recognition

President Svonkin reviewed the revised "RCP Recognition" form prepared by Dr. Winn and entertained suggestions, questions, or comments from the Board.

Dr. Winn suggested that a seventh criteria be added which asks how the accomplishments relate to the promotion of the mission of the Board.

President Svonkin moved that the form be implemented and include Dr. Winn's suggestion.

M/Mitchell/S/Winn
Unanimous: Chaturvedi, Mitchell, Renner, Stenson, Stern, Svonkin, Winn
MOTION PASSED

President Svonkin stated that he just envisioned recognizing good people and Barry helped put it together in a way that the board can be impartial and judge people based on set criteria which I think is outstanding.

12. PROFESSIONAL LICENSING COMMITTEE REPORT
(Larry L. Renner, RCP, Chair, Richard L. Sheldon M.D., Member)

Vice-President Renner advised the Board that they have been continuing to receive inquiries. And that the volume seems to have increased in recent months.

13. PRESENTATION BY THOMAS LOESCHER
DELIVERY OF ANESTHETIC AGENTS VIA MECHANICAL VENTILATION

Dr. Winn introduced Mr. Loescher and introduced this item by stating that more and more anesthesia machines are being brought into intensive care units for patients that are on ventilators for the purposes of administering anesthetics. However, RCPs are always asked the same question, is this within an RCPs scope of practice? Dr. Winn stated he would like to put this issue to rest. Dr. Winn urged the Board to consider the following and requested the Board to allow or approve and include this practice as part of the RCP's scope of practice:

1. 1) Scope of practice letters already show overwhelming support for RCPs to perform conscious sedation;
2. 2) The conscious sedation we currently use is not on intubated patients and this practice would be on intubated patients, which is a lot safer, and
3. 3) Within the RCPs scope of practice, it says exclusive of general anesthesia. This is not general anesthesia, this practice would keep patients at a higher level ofsedation.

Dr. Winn stated that Tom Loescher and Hudson RCI have brought this issue to the forefront because they have a device that would make this practice much easier. Dr. Winn stressed that it is not the device that the Board is commenting on it is the administration of an anesthetic agent to promote conscious sedation. The byproduct of this is a cost savings to facilities because we don't have to use Propofol and weaning would be better because patients wouldn't have to continually be going down and up.

President Svonkin asked if Mr. Tom Loescher wanted to say a few words.

Mr. Loescher explained the use of the device that will make delivering anesthetic agents easier. He explained the device is being used throughout Europe (prevalently in Germany, Sweden and Italy) and that it is currently under review by the Food and Drug Administration (FDA) and approval is expected by the end of the year. Mr. Loescher stated the device allows for the administration of local anesthetics, especially Isoflurane in a very safe and ethical manner. Mr. Loescher noted there have been studies published on this subject. He stated his company gets calls from RCPs throughout the United States every week about delivering Isoflurane in the Intensive Care Unit.

Dr. Winn would like the Board to go on record as recognizing that this administration is within our scope of practice.

Vice-President Renner stated that his facility has had two dozen similar cases. These patients are patients where you are using a generalized anesthetic agent but in a controlled environment in which the patient can still respond and still be at some alert level - and still controlled. One of the unique values of Isoflurane is that it is a specific bronchodialator for pulmonary vascular and we have seen tremendous results in the two dozen patients. But we have wrestled with this issue.

Mr. Mitchell noted that the agenda item was not noticed to take action. President Svonkin agreed and stated that it was the President's ruling that no action could be taken.

Ms. Scuri noted that there was a note made on the agenda that the Board could take action on any item listed. President Svonkin recommended and directed staff to place the issue on the November agenda without relation to the product, for action to be taken.

14. LEGISLATIVE/LEGAL AFFAIRS COMMITTEE REPORT
(Eugene W. Mitchell, Chair, Scott J. Svonkin, Member)

A. 2003 Legislation

AB 77
President Svonkin stated the recommendation of staff was to "oppose" SB 77. President Svonkin stated that his recommendation, although staff recommended to "oppose" SB 77, would be to "support if amended" to eliminate the specifics of allowing them to practice respiratory care without a license. Specifically, deleting reference to section 2620 subdivisions (b)(6).

Dr. Winn noted that suctioning is one of the most dangerous things that result in death for the patient. There are more sudden deaths due to suctioning in a hospital than any other procedure that we do. When I see "airway clearance techniques" it bothers me. There is a ground cell of professions that want to perform these techniques. Dr. Winn stated that he would tend to support staff and oppose this bill.

Vice-President Renner stated that he would recommend amending or opposing the bill.

President Svonkin requested Terry McHale from the audience to share the information he had on this bill.

Mr. McHale representing the California Society for Respiratory Care. Mr. McHale first noted that he wanted to say good-bye to Barry Winn.

Mr. McHale speaking: When I first met Barry it was during a very difficult time between the Board and the CSRC and you were never less than a gentleman. And I think just listening to you today and looking at the packet, though there have been some disagreements, I don't know of anyone who is a stronger advocate for the profession. The idea that your letters asking that we visit the scope of practice continues today. And although we have had disagreements I'm pleased and proud to have met you and I wish you and your family the best. I know that California has been well served.

Mr. McHale stated that his recommendation to the CSRC is to adamantly oppose the bill. But that his suggestion to the Board is different. Mr. McHale explained that the Board has a latitude in the Capital as partners with the Governor. He stated that supporting the legislation if amended will allow the Board to sit down with Senator Burton's staff and explain concerns. He added that they want to hear from the Board. Mr. Mitchell noted that supporting if amended allows the Board the leeway to negotiate and recommended support if amended.

M/Mitchell/S/Renner
Unanimous: Chaturvedi, Mitchell, Renner, Stenson, Stern, Svonkin, Winn
MOTION PASSED

SB 252
Ms. Scuri noted that this is a successor bill to a bill that passed last year or the year before. Prior to that bill Medical Assistants (MAs) could not be supervised by someone other than a physician. That bill that passed allowed MAs to be supervised by nurses and physician assistants in certain settings. This bill removes the restrictions on the settings so now MAs can be supervised by physicians, nurses, and physician assistants in any setting.

Vice-President Renner expressed concern with the leeway afforded to MAs with regards to supervision. Vice-President Renner pointed out that the letter presented from the Medical Board states MAs perform only non invasive procedures. Yet clearly when you review the questions and answers it is clear that they are doing invasive procedures by the simple fact that they are allowed to give injections of narcotics. Vice-President Renner stated there is a federal regulation that may be related that clearly states only licensed people should have either access or the ability to administer narcotics.

Ms. Irene Moreno, SEIU Local 250: This bill expands where medical assistants can work. They're trained to work in the front and back of the office, not in other areas.

Staff suggests that this be opposed because they are infringing on RCP boundaries and jeopardizing the health and safety of pulmonary patients.

Mr. Stern moved to accept staff's recommendation to oppose SB 252.

M/Stern/S/Winn
Unanimous: Chaturvedi, Mitchell, Renner, Stenson, Stern, Svonkin, Winn
MOTION PASSED

SB 363
Mr. Mitchell advised the Board that this bill will carry the Board's proposed language as identified in the attachment.

Mr. Mitchell moved to support this bill.

M/Mitchell/S/Winn
Unanimous: Chaturvedi, Mitchell, Renner, Stenson, Stern, Svonkin, Winn
MOTION PASSED

AB 751 and AB 803
President Svonkin noted that AB 751 and AB 803 are both intent language.

Mr. McHale noted that these are products of the budget crisis. Mr. Stern moved to give Chairman Mitchell the authority to act on behalf of the Board once there is language.

M/Stern/S/Chaturvedi
Unanimous: Chaturvedi, Mitchell, Renner, Stenson, Stern, Svonkin, Winn
MOTION PASSED

AB 1549
President Svonkin stated this was an excellent bill. There is a large coalition of supporters and this affects many of the patients that RCPs come in contact with. Dr. Winn moved to support.

M/Winn/S/Mitchell
Unanimous: Chaturvedi, Mitchell, Renner, Stenson, Stern, Svonkin, Winn
MOTION PASSED

Ms. Nunez noted that AB 1549 also includes the establishment of a workgroup of ten people in specific professions. Ms. Nunez suggested that while supporting the bill the Board attempt to have one of the members of the workgroup be a RCP. President Svonkin stated that he is directing staff to make this request.

AB 1777
President Svonkin advised the Board this bill contains technical and non substantive changes to the RCPA. Mr. Stern moved to support the bill. Mr. Mitchell requested that Board staff research if other boards or bureaus use collection agencies and report to the Board in November.

M/Stern/S/Winn
Unanimous: Chaturvedi, Mitchell, Renner, Stenson, Stern, Svonkin, Winn
MOTION PASSED

President Svonkin will work with staff to communicate to authors and committees the Board's positions.

President Svonkin asked the Board for approval and permission for the Legislative Committee to raise the visibility of the profession by getting a specific resolution and declaration from the Governor, Senate and Assembly for October as respiratory care awareness week or month.

M/Svonkin/S/Stenson
Unanimous: Chaturvedi, Mitchell, Renner, Stenson, Stern, Svonkin, Winn
MOTION PASSED

15. PUBLIC COMMENT ON ITEMS NOT ON THE AGENDA

Ms. Irene Moreno with Service Employees International Union (SEIU) Local 250 introduced herself and advised that they have 2,000 RCPs in their union from Northern California and will be moving to recruit more in Southern California. She stated that she looks forward to working with the Board.

Mr. Bob Bence, President, CSRC stated he was pleasantly surprised by the communication related to the Ethics course. Mr. Bence thanked the Board for their efforts and assistance.

16. FUTURE AGENDA ITEMS

Dr. Winn requested that the matter of conscious sedation be discussed in further detail. President Svonkin advised that this was already noted.

ADJOURNMENT

President Svonkin moved to adjourn the Public Session meeting at 3:30.

M/Svonkin/S/Chaturvedi
Unanimous: Chaturvedi, Mitchell, Renner, Stenson, Stern, Svonkin, Winn
MOTION PASSED