November 9, 2001 Board Meeting Minutes
RESPIRATORY CARE BOARD OF CALIFORNIA
BOARD MEETING
November 9, 2001
Ramada Inn
2900 North San Fernando Boulevard
Burbank CA 91504
(818) 843-5955
*PUBLIC SESSION MINUTES*
Larry Renner, RCP
Richard Sheldon, M.D.
Gary Stern, Esq.
Stephanie Nunez, Executive Officer
Christine Molina, Staff Services Manager
Stephanie Aguirre, Staff Services Analyst
CALL TO ORDER
The meeting of the Public Session was called to order at 10:05 a.m. by President Winn. A quorum was present and members introduced themselves.
APPROVAL OF AUGUST 10, 2001 PUBLIC SESSION MINUTES
President Winn moved to approve the August 10, 2001 Public Session Minutes as written.
M/Winn/S/Stern
Unanimous: Chaturvedi, Renner, Sheldon, Stern, Winn
MOTION PASSED
PUBLIC COMMENTS
Michael Gibbons, CSRC President:
Mr. Gibbons requested a public discussion explaining the process used to interview and score candidates for the office of Executive Officer of the Respiratory Care Board. In addition, he announced the CSRC's support of Mark Goldstein for this position.
President Winn summarized the chronological events in the process of selecting a candidate for the Board's Executive Officer position. President Winn stated that a copy of the chronological events will be mailed to Mr. Gibbons.
Barry Westling, Program Director, San Joaquin Valley College:
Mr. Westling stated, in his opinion, that the educators, health care administrators, health care institutions and the educational institutions are the best people to provide continuing education. He stated the focus should be on the content of the education not the mode of delivery. Computerization and the use of the Internet should not be overlooked as an effective delivery of this education. He added, the regulation and fees by the Board are unnecessary. They will eliminate many educational opportunities for individuals and are not consistent with the Board's mission. Mr. Westling suggested the Board look at other licensing boards to see how they handle continuing education.
Denise Reese, Santa Monica College graduate, Supervisor, Santa Monica UCLA Hospital, Instructor, Santa Monica East LA College Program:
Ms. Reese spoke as a representative for the students who were unable to attend this Board meeting. Ms. Reese expressed their concerns with the increase in the licensing fee and the cost and availability of C.E.U.'s.
The Board convened into Closed Session.
Public Session reconvened at 10:45 a.m.
EXECUTIVE OFFICER'S REPORT
[Stephanie Nunez, Executive Officer]
Internet License Look-up - Update
Ms. Nunez informed the Board and the public that the Board's website now allows for the capability to look up the status of any Respiratory Care Practitioners license including any disciplinary actions that have ever been taken against the RCP. Ms. Nunez explained the Department is working on getting another server to help speed up the system.
Complaint Disclosure
Ms. Nunez discussed the Department of Consumer Affairs (DCA) proposed plan for complaint disclosure. She explained this action began when an audit performed on the DCA found that consumers were not getting information in a timely manner. DCA would like the Board's opinion on changing it to allow a case to be disclosed as soon as it is sent to the Attorney General's office. Currently, the Board's policy is to disclose an accusation once it has been filed.
Mr. Buntjer explained that the issue is when to disclose a complaint filed against the practitioner. The earliest being as soon as the complaint is filed. The later is after it has gone through the investigation and review processes and referred to the Office of the Attorney General who prepares an accusation signed off by the Executive Officer.
Mr. Stern expressed his concerns with the public notification of complaints prior to an investigation and review and feels the current process should stay as is.
Discussion ensued.
Mr. Stern moved that the public disclosure of disciplinary matters remain at the accusation stage as it is presently.
Ms. Nunez asked if the Board would make considerations if the process gave notice to the accused allowing for a response to be filed along with the accusation. Ms. Nunez added that an investigation can take anywhere from three months to two years from the time the complaint is filed.
Discussion ensued.
Ms. Nunez added the intent is to make the disclosure policy a universal process across all the Boards, as it currently is not.
Mr. Stern stated that his motion stands.
M/Stern/S/Sheldon
Unanimous: Chaturvedi, Renner, Sheldon, Stern, Winn
MOTION PASSED
Newsletter Advertisement
Ms. Nunez stated that the Board is researching and considering the possibility of including advertising in the newsletter as a possible means of creating revenue without further impact to the licensing fees.
General Report
Ms. Nunez informed the Board that Ms. Molina, Staff Services Manager, delivered her child, Noah this week. President Winn requested that Ms. Nunez give Ms. Molina congratulations on the Board's behalf.
Ms. Nunez added that she has received numerous letters and phone calls praising the Board's Licensing Unit and wanted to acknowledge Monica Maldonado, Anna Juarez , Rae Woods, and Craig Martinez for their courteousness and helpfulness when assisting the public.
LEGAL COUNSEL REPORT
[Daniel Buntjer, Esq.]
Disciplinary Database Agreement
Mr. Buntjer stated that the National Board for Respiratory Care (NBRC) has a database for disciplinary decisions and actions taken by state licensing agencies. Boards that participate enter into an agreement with them requiring they send disciplinary action information to be included in the database. Mr. Buntjer stated the intent is that if a practitioner moved to another state and applied for licensure, the state in which he or she is applying could contact the NBRC and find out if there had been any disciplinary history. Ms. Molina has reviewed a proposed contract sent to the Board by the NBRC, made some revisions and returned it to the NBRC. Currently, the Board is awaiting a response and any reactions to the proposed amendments.
AB 192 (Chapter 243, 9/5/01): Amendments to Bagley-Keene Open Meeting Act
Mr. Buntjer informed the Board that amendments have been made to the Bagley-Keene Open Meeting Act. Under previous laws, the Board could hold a teleconference meeting by having one location open to the public at which one board member would be required to attend allowing other board members to participate from a location convenient for each. This law would change that process requiring a minimum of two locations open to the public. Board members wanting to participate would have to go to one of those two locations. This bill also provides a "definition" of what a meeting is and is not. Mr. Buntjer added that the bill consolidates various definitions of "State body" which now appear under a single section.
General Report
Nothing to report at this time.
EXECUTIVE/INTERNAL AFFAIRS COMMITTEE REPORT
[Barry Winn, Ed.D., RCP, President; Vacant, Vice-President]
Executive Officer Position Selection / Update
President Winn stated that in Closed Session the Board has selected Stephanie Nunez as the Board's Executive Officer and added that a copy of the chronological events of the process will be available upon request.
Presentation to Daniel Buntjer, Esq.
President Winn explained that Mr. Buntjer has been with the Board for the past eighteen years and will soon be retiring. Since this is his last meeting with the Board, he was presented with an award and extended the Board's appreciation.
Mr. Buntjer said it has been a privilege and honor to serve the Board and expressed his appreciation for the input received by the profession, the program directors and the association as it has been very helpful in making good policy decisions.
Budget / Fund Condition
Ms. Nunez entertained questions from the Board regarding the Budget Report, Revenue Report, and Fund Condition.
Renewal Fee
Dr. Sheldon stated it was his understanding that, by law, the Board can only raise the renewal fee by 10%, which would increase the fee to $210. Mr. Buntjer responded explaining, in 1999, the Legislature gave the Board the authority to increase the renewal fee from $200 to $230, although it was not implemented at that time.
President Winn commented that approximately 70% of enforcement costs are actually incurred by 2% of the population. He stated the continued professional conduct of the Respiratory Care Practitioners can actually help reduce those fees.
Mr. Chaturvedi added that the Board should try and keep the costs down as much as possible.
PUBLIC COMMENTS
Michael Gibbons, CSRC President:
Mr. Gibbons stated that he did not see the actual vote for the renewal fee increase. Mr. Stern informed Mr. Gibbons that page 6, line 11 of the minutes states, "The Board will implement the $30 fee increase effective January 1, 2002". In addition, he quoted where Ms. Nunez stated that in January 1999, a $30 renewal increase went into effect but was not implemented. Budget conditions show that this fee increase needs to be implemented effective January, 2002 for the Board to stay "fiscally solvent". Mr. Stern added no motion is needed in this case.
Mr. Gibbons requested an explanation of the deficit.
Ms. Nunez explained that the deficit has actually accumulated over a number of years. In 1994, about 1 million dollars was removed from the RCB's fund by the legislature and, as a result, budget cuts were made. The revenue was returned two years later creating a surplus which has sustained the Board since that time. However, expenditures have continued to exceed revenues depleting that fund.
Mr. Stern added that mandatory reporting has also caused a shift in the enforcement budget. He also expressed his optimism that the introduction of the new disciplinary guideline manual will cause a dramatic reduction in enforcement costsover time.
General Report
Nothing to report at this time.
SUNSET REVIEW TASK FORCE
[Barry Winn, Ed.D., RCP, President; Vacant, Vice-President]
Sunset Review - Update
Ms. Nunez stated that the Sunset Review report can be viewed on the RCB's website. She added, the hearing will be held on December 5, 2001 at 9:00 a.m. and the public is invited to attend and give testimony. Ms. Nunez explained that the Sunset Review is a process established by Senator Boatwright, wherein all boards under the Department of Consumer Affairs are reviewed every two, four, six or eight years, to determine if they are functioning as they should and protecting the consumer.
The three options for the Sunset Review Committee are:
- 1. Allow the Board to continue as is.
- 2. Dissolve the Board and place them under DCA's direction.
- 3. Re-constitute the entire Board, eliminating current board members and appoint new ones.
LEGISLATIVE/LEGAL AFFAIRS COMMITTEE
[Gary N. Stern, Esq., Chair; Vacant, Vice-President, Member]
2001 Legislation Update
Mr. Stern highlighted the status of pending legislation as they were put on a "Watch" position by the Board in previous meetings:
2002 Proposed Legislation
The proposed legislative amendments are as follows:
Ms. Nunez requested that the Board give the Legislative Committee the authority to move forward with legislation if needed before the next Board meeting.
Discussion ensued.
Mr. Stern moved to have the Board authorize the Legislative Committee to proceed with recommendations of legislation for the next session, subject to receipt of comments from interested parties (including CSRC) before the Board takes position or seeks to have them introduced into the legislature.
M/Stern/S/Renner
Unanimous: Chaturvedi, Renner, Sheldon, Stern, Winn
MOTION PASSED
Recognition of RCPs under the Medicare Home Health ServicesBenefit
Mr. Stern moved that the proposed letter be sent to congressman Pete Stark, U.S. House of Representatives, regarding access to respiratory therapists in the home. Under current law, home health care can be rendered and respiratory care given but the federal medicare regulations may not permit the reimbursement of those services.
Dr. Sheldon requested an addition be made to Mr. Stern's motion to include attachments of documents written by the AARC Board member advisors (representing about twenty different national organizations) stating that if respiratory care is ordered by a physician the only person acceptable to deliver that care is a licensed respiratory therapist. Dr. Sheldon also suggested the letter include a small paragraph noting these national organization indicate it is only acceptable to them to have that care delivered by a licensed, certified Respiratory Care Practitioner.
Mr. Stern amended his motion to reflect Dr. Sheldon's comments
M/Stern/Sheldon
Unanimous: Chaturvedi, Renner, Sheldon, Stern, Winn
MOTION PASSED
President Winn requested that Dr. Sheldon prepare the paragraph to be added to the letter.
General Report
Nothing to report at this time.
ENFORCEMENT COMMITTEE REPORT
[Barry Winn, Ed.D., RCP, Chair, Gary N. Stern, Esq., Member]
Proposed Enforcement Guidelines / Proposed Cite and Fine Regulations
Mr. Stern explained that the Board has been provided (as well as CSRC) with a proposed disciplinary guidelines manual (a working document) designed to update and prioritize the Board's enforcement functions. Mr. Stern submitted some proposed changes for the Board's review.
Mr. Buntjer suggested that the Proposed Disciplinary Guidelines Manual be amended highlighting Mr. Stern's proposed changes and be presented at the next Board meeting. The Board agreed to comply with Mr. Buntjer's suggestion.
Discussions were held for each of the proposed amendments.
Mr. Stern moved that staff work with Legal Counsel and return to the board with a revised document for review.
M/Stern/S/Chaturvedi
Unanimous: Chaturvedi, Renner, Sheldon, Stern, Winn
MOTION PASSED
Enforcement Statistics
Ms. Nunez explained that the increase in the Enforcement Budget from Fiscal Year 2000/2001 ($361,031) to Fiscal Year 2001/2002 ($691,168) was a result of a budget change proposal submitted increasing costs for the Attorney General, Office of Administrative Hearings and expert witnesses. Ms. Nunez added these costs are directly related to the complaints received through mandatory reporting. Ms. Nunez explained these are budgeted amounts and will only be spent if necessary.
General Report
Nothing to report at this time.
PUBLIC COMMENTS
Denise Reese, Santa Monica College graduate, Supervisor:
Expressed her concerns over the difficulty in substantiating records five years back. Ms. Reese also requested an extension of the due date for quarterly reports from the current seven day period to a ten day period.
Mr. Stern requested Ms. Reese submit her request, in letter format, to the Board.
Ms. Nunez stated the guidelines were modified so that supervisor quarterly reports will not necessarily be recommended for all disciplinary cases which may help reduce the load for Ms. Reese.
Michael Gibbons, President, CSRC:
Congratulated Ms. Nunez on her appointment to the Board's Executive Officer position and congratulated Mr. Buntjer in his upcoming retirement. Mr Gibbons expressed his concern with the License Penalty Determination Guidelines in that it seems the DUI penalties for the licensee are unchanged remaining at probation or revocation for two or more offenses.
Mr. Stern stated that was intended to be for two or more separate incidents (on different occasions) and should be noted as such. Mr. Stern suggested, and Ms. Nunez agreed that the wording be changed to reflect this.
Person Unidentified:
Expressed her concern in the fact that the violations seem to be focusing more on the importance a child's life rather than a life in general.
Mr. Stern responded, stating he was comfortable with the way it is written.
Virginia Ettinger, Program Director:
Congratulated Ms. Nunez on behalf of herself and Dr. Leroy Misuraca on her appointment to the Executive Officer position.
In regards to the Executive Officer's Report, Ms. Ettinger inquired whether Statement of Issues are also included referring to complete disclosure. Ms. Nunez replied that Statement of Issues are included.
Concerning the Proposed Legislative Amendments 2002, Section 3750.5, Ms. Ettinger inquired whether "use" of any controlled substance, as a violation, was referring to use in general or use on the job.
Mr. Buntjer responded this would depend whether use off the job is substantially related.
On behalf of Cynthia Molle, LeRoy Misuraca, Peter Margand, Muriel Holmes, and herself, Ms. Ettinger wished Mr. Buntjer the best in the future and thanked him for his support over the years.
Michael Gibbons, President, CSRC:
Requested a copy of the NBRC Disciplinary Database
Ms. Nunez responded that it is still in the draft stage at this point but she could provide the CSRC with a copy of what was sent to the Board by the NBRC.
Person Unidentified:
Expressed his concerns about over zealous or unreasonable consumer protection laws at the expense of the rights of the practitioners. He added recruitment in respiratory therapy is becoming a more critical issue and enrollment in respiratory programs is declining. He stated, in his opinion, the Board needs to focus not on impeding but rather promoting the Respiratory Therapist profession.
PROFESSIONAL & COMMUNITY RELATIONS COMMITTEE
[Richard L. Sheldon, M.D., Member]
General Report
Nothing to report at this time.
UNLICENCED PERSONNEL TASK FORCE
[Barry Winn, Ed.D. RCP, Richard L. Sheldon, M.D.]
Pulmonary Function Testing / Home Care
Mr. Renner stated the issue at hand is making sure quality pulmonary diagnostic testing is provided as well as looking out for the consumer's interest. Mr. Renner stated, from his prospective, the National Board already has, in place, the mechanism by which people can become C.P.F.T.'s or R.P.F.T.'s which should be recognized as such by an amendment to the licensure.
Mr. Renner also expressed concerns that Physicians offices are commonly using unlicenced personnel to perform pulmonary function testing.
Dr. Sheldon moved that the Board pursue a mechanism, and report back to the Board, that would allow for quality control issues to be imposed on out patient labs that meet the criteria set forth by California Thoracic society or any of the other organizations that have already expressed their opinions, and that the Board be prepared to issue discipline in the event it is necessary.
Mr. Renner requested a modification to Dr. Sheldon's motion that there also be a definition of pulmonary function testing incorporated in the practice act.
M/Sheldon/S/Renner
Unanimous: Chaturvedi, Renner, Sheldon, Stern, Winn
MOTION PASSED
General Report
Nothing to report at this time.
EDUCATION COMMITTEE REPORT
[Barry Winn, Ed.D., RCP, Chair, Gopal D. Chaturvedi, Member]
Proposed Continuing Education Provider Approval Regulations
Ms. Nunez stated the intent behind the CE Provider Approval- Proposed Regulations is to assert some quality control in the continuing education programs taken by Respiratory Care Practitioners.
Ms. Nunez commented that one of the issues receiving opposition is concerning the non-acceptance of home study and internet based courses. She added another issue being raised is concerning Section 1399.362 and the limits surrounding CE credits received for examinations.
President Winn requested the Board put together a strategic planning meeting to prioritize and discuss the issues followed by hearings both in southern and northern California which would include the information from that meeting.
Transcript Review / Program Director Survey
President Winn thanked the program directors in participating and submitting the surveys sent to them.
Ms. Nunez stated opinions have been expressed that the Transcript review is a duplicated process. In the past, only Certificates of Completion were required in the application process but a study performed, approximately five years ago, found inconsistencies and even instances of certificates being inappropriately issued. She explained as a result, transcript review began. Ms. Nunez asked the Board how they wished to pursue with the transcript review.
Ms. Nunez added that the Board would lose $75,000 a year if the transcript review process is eliminated.
Mr. Renner moved that this issue be reviewed at the Strategic Planning meeting with regards to its operational impact on the Respiratory Care Board and that a recommendation be made as to how to phase this out as it is obviously duplicated.
M/Renner/S/Sheldon
Unanimous: Chaturvedi, Renner, Sheldon, Stern, Winn
MOTION PASSED
PROFESSIONAL LICENSING COMMITTEE REPORT
[Richard L. Sheldon M.D., Chair, Larry L. Renner, RCP, Member]
Scope of Practice Correspondence
Dr. Sheldon requested that Mr. Renner review and respond to the scope of practice letters received, with copies of all information being sent to Dr. Sheldon. Dr. Sheldon added that Mr. Renner can consult with him when needed for advice and consent.
Mr. Stern moved that the scope of practice letters be approved and adopted as written.
M/Stern/S/Chaturvedi
Unanimous: Chaturvedi, Renner, Sheldon, Stern, Winn
MOTION PASSED
General Report
Nothing to report at this time.
2002 & 2003 BOARD MEETING DATES
The next board meeting is schedule for Friday February 22, 2002 in Sacramento. A strategic planning meeting is also scheduled to take place Thursday evening, February 21, 2002.
ELECTION OF OFFICERS
Mr. Stern moved that Mr. Winn be re-elected as President of the Respiratory Care Board.
M/Stern/S/Chaturvedi
Unanimous: Chaturvedi, Renner, Sheldon, Stern, Winn
MOTION PASSED
President Winn moved that Mr. Renner be elected as Vice-President of the Respiratory Care Board.
M/Winn/S/Sheldon
Unanimous: Chaturvedi, Renner, Sheldon, Stern, Winn
MOTION PASSED
DATES OF IMPORTANCE
10th of Every Month: Deadline to Submit Per Diem/Travel for Previous Month
Monday, November 12, 2001: Veterans' Day Observed
Thursday & Friday, November 22 & 23, 2001: Thanksgiving Holiday Observed
Tuesday, December 25, 2001: Christmas Holiday Observed
Tuesday, January 1, 2002: New Years Day Observed
Monday, January 21, 2002: Martin Luther King Jr.'s Birthday Observed
ADJOURNMENT
As all items on the agenda were discussed, President Winn adjourned the Public Session at 1:48 p.m.
