November 8, 2002 Board Meeting Minutes

BOARD MEETING
PUBLIC SESSION MINUTES

November 8, 2002

The Courtyard by Marriott
6161 West Century Boulevard
Los Angeles CA 90045
(310) 649-1400

CALL TO ORDER

The Public Session meeting was called to order at 9:35 a.m. by Vice-President Renner. A quorum was present.

APPROVAL OF JULY 19, 2002 PUBLIC SESSION MINUTES

Mr. Svonkin moved to approve the July 19, 2002 Public Session Minutes as written.

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

EXAMINATION CONTRACTS

The Board determined that the current exam process, which allows for the administration of the licensing examination by two providers, has ultimately caused confusion among applicants and placed a burden on program directors getting needed statistical information.

After reviewing responses from an equal number of applicants surveyed who took their licensing exam with Experior or the National Board for Respiratory Care (NBRC), and based on separate survey results from California program directors, the Professional Licensing Committee made a recommendation to the full Board to terminate its existing contract with Experior and maintain the NBRC as its sole examination provider.

Mary-Alice Coleman stated that she has reviewed the Board's contract with Experior for possible termination. She stated that the termination clause provides several options including cancellation for "convenience of the state or in the states best interest." To begin termination, the process outlined in the contract provides that the Board must deliver a notice of termination, date of termination, and extent of termination to Experior. The contractor is then obligated to provide the Board a final termination settlement proposal, including any settlement amount, within 90 days.

Mr. Stern asked Ms. Coleman if it is appropriate for a motion to be made which allows Ms. Nunez to proceed in terminating the Board's contract with Experior as soon as possible so long as there is no financial burden to either the contractor or the state.

Mr. Svonkin moved that the Board move forward with terminating its existing contract with Experior, pursuant to all applicable terms and conditions of DCA's contract with Experior, and to move forward to maintain the NBRC as the only exam provider.

M/Stern/S/Svonkin
Unanimous: Chaturvedi, Mitchell, Renner, Sheldon, Stenson, Stern, Svonkin, Winn
MOTION PASSED
[Mr. Eugene Mitchell arrived.]

CALIFORNIA CODE OF REGULATIONS SECTION 1399.341
RE: EXAMINATION PATH - DISCUSSION / VOTE
(No Public Testimony Taken)

After review of the language and comments received, Mr. Svonkin moved to adopt the final language as presented.

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

Dr. Sheldon moved that, should the need for this regulation become unnecessary due to the termination of the Board's contract with Experior, staff proceed in withdrawing the proposed establishment of this section.

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

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

Strategic Goals and Objectives - Status

Ms. Nunez asked the Board if there were any questions regarding the status of the Strategic Goals and Objectives. Ms. Nunez then advised the Board that a list of Congressional Committees had been compiled and distributed as a tool to seek support for legislation and regulations to recognize RCP's under the Medicare Home Health Services Benefit.

Mr. Svonkin moved that during the first quarter of the next calendar year, he arrange for two members (a RCP and a public member) to meet with various Congressmen to gather support regarding this issue.

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

Sunset Review Recommendations - Status

Ms. Nunez stated that the Board has already met many of its strategic goals and objectives and continues to work toward completing other established goals and objectives outlined in its Strategic Plan.

[President Barry Winn, Ed.D., RCP arrived.]

Enforcement Overview

Ms. Nunez summarized the enforcement processes and entertained questions from the Board.

Proposed Regulatory Amendments: Technical Amendments & Education

Ms. Nunez requested that staff be allowed to move forward with the proposed regulatory amendments regarding the technical amendments and education, with the exception of 1399.321(c) which was deemed unnecessary.

Dr. Sheldon expressed his concern with the high fees and stated that he would like to see fee reductions.

Mr. Svonkin moved that staff move forward to begin the regulatory process regarding the proposed language.

M/Svonkin/S/Winn
Ayes: Chaturvedi, Mitchell, Renner, Stern, Svonkin, Winn
Abstain: Sheldon, Stenson
MOTION PASSED

EXECUTIVE COMMITTEE REPORT
(Barry Winn, Ed.D., RCP, President; Larry L. Renner, RCP, Vice-President)

Fiscal Analysis

Ms. Nunez informed the Board that the format for the revenue, expenditure, and fund condition had been consolidated as part of the annual fee review process. Ms. Nunez explained that the Board has narrowed the gap between revenues and expenditures by reducing its Attorney General line item, and reducing the number of enforcement staff positions.

Ms. Nunez entertained questions from the Board.

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

Enforcement Statistics

Mr. Stern entertained questions from the Board regarding the enforcement statistics.

Cite and Fine Regulations - Status

Mr. Stern suggested the possibility of withdrawing the proposed regulations in light of the development of the cost recovery issue in the Zuckerman case. Ms. Coleman stated that in August, the supreme court rendered its decision in the Zuckerman v. Board of Chiropractic Examiners and that it is her opinion that several laws will now need to be fine-tuned due to this ruling.

Ms. Nunez stated that she spoke with DCA's Senior Legal Counsel and was advised that the Board already has the authority to issue citations and fines to applicants, therefore, the language proposed in section 1399.378 was unnecessary and should be withdrawn.

Discussion ensued regarding both issues.

Mr. Mitchell moved to give Ms. Nunez the authority to proceed with the regulations after removing all references to applicants and cost recovery and making any technical amendments, provided no comments objecting the changes are made.

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

OUTREACH COMMITTEE
(Scott J. Svonkin, RCP, Chair; Gopal Chaturvedi, Member)

General Report

Mr. Svonkin expressed his pleasure with the results of the various outreach projects the Board has been participating in and hopes it will continue. He added that the profession would benefit by having a spokesperson or a re-occurring role on a television show promoting the respiratory care profession.

President Winn inquired if a Power Point type presentation could be developed to broaden the outreach effort. President Winn stated that it would be beneficial to have a five minute introduction into the respiratory care profession for use by program directors.

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

Correspondence
(2002-C-25 through 2002-C-38)

Ms. Nunez stated that she was informed by DCA's Legal Counsel that the scope of practice letters should not be included on the Board agenda, and that all response letters should include a phrase stating that the response is a "declaratory decision of the Board" to protect it from possible litigation.

Mr. Stern suggested that the response letters be considered an "opinion" and not a "ruling." He further suggested that the content of the letters be modified to suggest the inquirer obtain legal counsel.

Discussion ensued.

It was decided that all scope of practice response letters will still be provided to the Board and will be available to the public on the Board's website, but will not be included as an agenda item for future Board meetings.

Dr. Sheldon moved to allow Board staff to modify response letters to include a disclaimer which will be approved by DCA's Legal Counsel.

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

Vice-President Renner moved to approve the scope of practice response letters as written.

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

PUBLIC COMMENT

Virginia Ettinger, LA Valley College: Ms. Ettinger complimented the Board on its continued efforts to bring awareness to the respiratory care profession. In addition, Ms. Ettinger offered her assistance in contacting television writers to promote the respiratory care profession by including RCP roles on television.

Ms. Ettinger stated that she had been approached by licensees who had recently received solicitation type calls from individuals stating they had been provided licensee telephone numbers from the Board. Ms. Nunez indicated that she did not believe telephone numbers were distributed, however, she advised Ms. Ettinger that should would confirm with DCA's Public Sales Unit that this practice was not occurring.

Alison Murray, Apria HealthCare: Ms. Murray applauded the Board's decision to take action against unlicensed individuals who perform respiratory care in the homecare setting.

Sam Giordano, Executive Director, American Association of Respiratory Care: Mr. Giordano stated that the public image and awareness of respiratory therapists must be raised just as it has been for physicians and nurses.

Mr. Giordano stated that the AARC is beginning to obtain some recognition due to the diagnosis of COPD in comedian Robert Kline. The AARC has posted a photo of Mr. Kline on its website.

Bob Bence, President, CSRC: Mr. Bence introduced himself to the Board and offered the CSRC's assistance in any way needed.

Mr. Bence added that the scope of practice response letters are very important to the respiratory care practitioners in obtaining the "do's and dont's." He further stated that the Board should be precise when responding to the inquiries received.

UNLICENSED PERSONNEL TASK FORCE
(Barry Winn, Ed.D., RCP, Chair; Richard L. Sheldon, M.D., Member)

Establishment of New Task Forces

The following board members were designated to participate in the task forces listed below.
Home Care Task Force: Chair: Mr. Svonkin; Member: Ms. Stenson
Pulmonary Function Task Force: Chair: Dr. Sheldon
Cardiac Catheter Laboratory Task Force: Chair: Mr. Renner
Polysomnography Task Force: Chair: Ms. Cooper

Ms. Rose Anne Zumstein offered her services to the Polysomnography Task Force. President Winn thanked her for her willingness to help.

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

2002 Chaptered Legislation

Mr. Svonkin highlighted some of the legislative changes which would become effective on January 1, 2003 and asked the Board if there were any questions regarding any of theprovisions.

2003 Board-Sponsored Proposed Legislation

Mr. Svonkin summarized the 2003 proposed legislation and entertained questions regarding the proposals.

Recognition of RCPs under the Medicare Home Health Services Benefit

Mr. Svonkin stated the Board should seek Congressional support for the inclusion of RCP's under the Medicare Home Health Services Benefit and to attempt to obtain a Resolution documenting support toward reaching this goal.

11:30 AM - 12:15 PM LUNCH

RCP RECOGNITION: LON LANCASTER, CLINICAL COORDINATOR OF
CARDIOPULMONARY SERVICES, KERN MEDICAL CENTER

The Board recognized Lon Lancaster, RRT, RCP for his outstanding performance and dedication to the respiratory care profession. Mr. Lancaster was nominated by the entire Respiratory Care Department at Kern Medical Center. Mr. Lancaster was licensed in 1985 and has been employed at Kern Medical Center since 1988. Mr. Lancaster's contributions include his dedication to the education and training of respiratory therapists, nurses, and resident physicians and his assurance that RCP students receive the most of their clinical rotation. In addition, he co-authored a paper on the VDR4 ventilator and works with One Legacy, a transplant organ donation network.

President Winn thanked Mr. Lancaster for his dedication and contributions to the respiratory care profession.

SAM GIORDANO, EXECUTIVE DIRECTOR, AMERICAN ASSOCIATION
OF RESPIRATORY CARE PRESENTATION
(Continuing Competency/Medicare Home Health Services Benefit)

Mr. Giordano stated that in 1998, the PEW commission issued a publication entitled Strengthening Consumer Protection. The publication resulted from the work of an established task force asked to anticipated the growth, advancement, and state of healthcare for the upcoming 25 years. While the booklet is not specific to the respiratory care profession, Mr. Giordano stated that it offers valuable information and encouraged the Board to obtain copies.

Mr. Giordano addressed the Board regarding continuing education and continued competency and then entertained questions from the Board and the public.

President Winn and each member thanked Mr. Giordano for his presentation.

Mr. Giordano added that AARC has long been fighting the battle for recognition of RCPs under the Medicare Home Health Services Benefit and he commended the Board for making this an important issue.

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

Proposed CE Regulatory Amendments

Ms. Stenson stated that the Education Committee met on October 18th in Burbank to discuss the proposed continuing education language. Ms. Stenson stated the Committee's recommended proposed regulatory language is before them.

Michael Martin, RC Educational Consulting Services, Inc.: Mr. Martin, suggested that the "two lists" be joined together. Ms. Nunez supported this suggestion and explained to the Board the amendment would be strictly technical and would not change the effect of the proposed language.

Bob Bence, President, CSRC: Mr. Bence stated that he had concerns with sections 1399.351(e)(4); 1399.351(e)(10); and 1399.352(f).

Ms. Stenson advised the Board that two round table meetings had been held to gather input and that the final language is being presented to the Board for approval to begin the regulation process.

Ms. Stenson then moved for the Board to adopt the proposed language with suggested "technical" changes and begin the regulatory process.

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

Foreign Education

President Winn apologized to Jasmine Singh for having to postpone her presentation since Ms. Cooper was unable to attend this meeting.

Ms. Stenson indicated that the Board's current method for evaluating foreign-educated applicants is not effective and has resulted in an additional set of educational criteria, inferior to the education criteria required for U.S.-trained applicants. Evaluation services do not have the means to consider the use and type of each and every foreign school's modalities, technology, and clinical experience that is, in some cases, decades behind the advancements and standards in the U.S. specific to the science of respiratory care. Therefore, Ms. Stenson indicated that it is the belief of the Education Committee that this dual standard is not in the best interest of California residents, jeopardizing their health and safety, and potentially undermines the quality and professional standards of the profession. Ms. Stenson noted that education obtained in Canada is the only education earned in a foreign country that meets or exceeds U.S. standards.

Ms. Coleman advised that the Board is required by law to accept all forms of foreign education if formal evaluations provide education as equivalent. Ms. Coleman stated the Board had no other options unless a legislative change was made.

Dr. Sheldon moved to pursue the necessary legislative amendments to ensure equal education criteria for all applicants.

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

Education Waivers - Proposed Regulations

Dr. Sheldon moved that the Education Committee fine tune the definitions of "good standing" and "work experience" for inclusion in the Technical Amendment & Education regulatory package.

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

PUBLIC COMMENT

Virginia Ettinger: Suggested a change be made to Business and Professions Code section 3740(c) to define "documentary evidence."

Ms. Coleman advised that a regulatory change defining documentary evidence would not be acceptable and that a legislative change was still necessary.

President Winn requested that Ms. Ettinger provide her suggestions Ms. Nunez.

2003 MEETING DATES
[& LOCATIONS]

May 16TH: San Francisco; August 22ND: Sacramento (IF NEEDED); November 14TH: San Diego

ELECTION OF OFFICERS

Mr. Mitchell moved to nominate Mr. Svonkin as President for 2003.
M/Mitchell/S/Sheldon

President Winn moved to nominate Mr. Renner as President for 2003
M/Winn/S/Stern

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

Mr. Svonkin will serve as President for 2003.

Mr. Svonkin moved to nominate Mr. Renner as Vice-President for 2003.

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

ADJOURNMENT

President Winn moved to adjourn the Public Session meeting at 2:00 p.m.

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