November 14, 2003 Board Meeting Minutes

BOARD MEETING
PUBLIC SESSION MINUTES

November 14, 2003

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

ELECTION OF OFFICERS

Vice President Renner moved that this agenda item be delayed and discussed at the end of the meeting.

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

ENFORCEMENT PROCESS OVERVIEW
(Presented by the Honorable Jaime Rená Román, Presiding Judge of Sacramento, Office of Administrative Hearings and Mara Faust, Deputy Attorney General of Sacramento Office of the Attorney General)

President Svonkin introduced Jaime René Roman, Presiding Administrative Law Judge (ALJ) and Mara Faust, Deputy Attorney General (DAG). President Svonkin stated that both would be presenting an overview of the enforcement process.

Deputy Attorney General Mara Faust introduced herself to the Board stating she has been a DAG in the Health Quality Enforcement Section, at Sacramento, since 1992.

Ms. Faust presented an overview of the prosecution of a RCB case: When the Board transmits a case to the Attorney General's Office, they first read the file and determine if there is enough information to file an accusation against the licensee. In cases of criminal conviction, the DAG checks the case law to make sure the crime is substantially related to the practice of an RCP (alcohol, drug abuse, etc). If there are no statutes defining the substantial relationship, the case and/or information will be referred to an expert witness for their review and expert opinion. Cases of "quality of care" are reviewed by an expert witness, as well, to determine whether the RCP is performing their job based on the standard of care. In cases of sexual misconduct (bad acts with no criminal conviction) the DAG will interview the victim before making the decision to file. If there's not enough information that is substantial, the DAG may decide to not file. If that occurs, the DAG may send a letter to the Board requesting additional information. Occasionally, a DAG may decline to file a case if clear and convincing evidence is not sufficient to meet the burden of proof. If there is insufficient evidence and the DAG declines to file, a letter will be sent to the Board's Executive Officer with an explanation. Marginal cases that may not be provable, occasionally get pled on the understanding there will be liberal, flexible settlement negotiations with the Board representative. In some cases, the statute of limitations is an issue. If it is close to the statute deadline, a settlement may be reached. Ms. Nunez has authority to settle a case, within the disciplinary guidelines. In settlement cases, the Board will receive a letter notifying them of such.

Ms. Faust continued explaining Separation of Power: The California Constitution separates government into three branches: Legislative, Executive and Judiciary. Some of these powers have been sub-delegated accordingly: Executive: RCB's Executive Officer (Ms. Nunez); Judicial: Office of Administrative Hearings; Legislative: The Board and delegated sub-committees. To preserve the separation of power, the law requires that executive and judiciary powers not communicate on cases because each is serving a separate branch. This is a constitutional requirement. A decision should be based on the information provided by the settlement or the hearing officer's proposed decision.

Ms. Faust described the Board's Pre-Trial Options: Ms. Nunez has authority to cite and fine. Currently, a rule is pending to expand the cite and fine powers, limited under the Board's statutory scheme. A lot of issues can be resolved through cite and fine as opposed to going through the full litigation process. Another pre-accusation option is filing under Business and Profession Code 820 & 822, a petition to compel a psychiatric evaluation which is appropriate under extreme behavior. An Interim Suspension Order (ISO) is another option under, Govt. code 11529. An ISO seeks immediate suspension or revocation of the RCP's license without a full hearing. Because this order denies due process it is necessary to show that the licensee's conduct poses a severe danger to the public. If the ALJ grants an ISO, a full hearing on declaration must be scheduled within 20 days or the ISO is dissolved.

Ms. Faust explained Burden of Proof and the differences in the types of cases: The three branches of law are Civil, Criminal and Administrative. The burden of proof varies within the three branches. For civil cases, the burden of proof standard is low, while a criminal case has a high burden of proof and lies beyond a reasonable doubt. Administrative cases (those that the Board deals with) require a middle standard of proof. In an administrative hearing, the rules of evidence are somewhat relaxed. Hearsay is admissible but can not, however, be the entire bases of the findings. In a criminal case, hearsay is not admissible. An additional difference between the two types of cases is that a defendant can be called to testify in an administrative hearing, while in a criminal hearing they can not, as they have the right against self incrimination.

Ms. Faust explained the Board's options concerning the ALJ's Proposed Decisions: Hearings are before an Administrative Law Judge of the Office of Administrative Hearings. When the administrative hearing is over, the ALJ writes a proposed decision which the Board has the option to adopt or non-adopt (if they feel it is not appropriate). If the Board non-adopts the decision, they must order the full hearing transcript and invite both sides to submit written arguments. This process is time consuming andcostly.

Rene Roman, Presiding Administrative Law Judge (ALJ), introduced himself as the presiding judge of the Sacramento region's Office of Administrative Hearing since 1994. He stated there are eight ALJ's assigned to the Sacramento office and they handle cases for over 700 agencies with DCA being only one of those. Judge Roman explained, the ALJs rely on pleadings they get, with regard to whether it's an accusation, a statement of issues or a petition to revoke probation. Medical discipline cases are prosecuted under the Health Quality Enforcement Section. Clear and convincing burden of proof is applied because an RCP licensee is professional as opposed to an occupational licensee (such as a vehicle salesperson). Judge Roman stated there seems to be an apparent lack of awareness surrounding the fact that alcohol or substance abuse has a nexus with regard to the respiratory care profession. An RCP's code of ethics requires professional conduct at all times.

Mr. Stern asked if this connection between substance abuse and unprofessional conduct is common in the other health boards. Judge Roman responded, yes, one profession even requires their licensees, as students, to attend a petition for reinstatement hearing educating them on the connection between personal and professional conduct.

Judge Roman stated that there are three types of cases: (1) substance abuse (2) quality of care and (3) sexual. He added that the quality of expert witness cases have essentially become a "battle of the experts" from each side where the judge must weigh the credibility and competence of the expert witness.

Vice President Renner inquired what would be considered discoverable and if an employee's file or medical record can be obtained. Ms. Faust replied that a subpoena would need to be obtained through the use of a DOI Investigator. Ms. Nunez added that the DOI is responsible for numerous boards and prioritizes the cases received. Obtaining records for the RCB usually is not a high priority. Ms. Nunez informed the Board that staff have been performing this function. She added, the Board has proposed legislation to obtain authority to issue subpoenas. Ms. Faust agreed that since the RCB staff is performing the investigations, they should also have subpoena power.

Dr. Sheldon inquired whether the State of California has or will have standard requirements to be an expert witness adding he's been requested on numerous occassions to serve as an expert. Judge Roman explained that an expert should have advanced knowledge in a specific area and strong credibility. He added that part of Dr. Sheldon's credibility might lie on the fact that he holds a position on a licensing board.

President Svonkin expressed his concerns over receiving proposed decisions to extend probation in cases where the individual has had a second drug offense while already on probation. Mr. Roman replied it is within the Board's privy to set the position of the Board.

President Svonkin thanked both Deputy Attorney General Faust and Judge Roman for sharing this information. Judge Roman commended the Board for honoring the RCP's who serve in the military explaining as a Colonel in the Army Reserve, it really does mean something to be acknowledge in this way.

ARGUMENTS IN THE NON-ADOPTION OF THE DECISION IN THE MATTER OF COLIN HOWARD

Mr. Stern moved to remove agenda item #4(a) from the agenda.

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

CLOSED SESSION

The Board convened into Closed Session at 10:35 a.m., as authorized by Government Code section 11126(c)(3), and reconvened into Public Session at 11:24 a.m.

APPROVAL OF MAY 16, 2003 PUBLIC SESSION MINUTES

Mr. Stern moved to approve the May 16, 2002 Public Session Minutes.

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

CALIFORNIA CODE OF REGULATION SECTIONS 1399.301 - 1399.395
RE: Technical Amendments and Education

Ms. Nunez pointed out that the blue section in the agenda binders represents additional changes that were made at the request of the OAL and the yellow section represents technical changes made.

Mr. Stern moved to adopt the Technical Amendments and Education regulations.

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

CALIFORNIA CODE OF REGULATIONS SECTION 1399.391
RE: Citation and Fine - Unlicensed Personnel

Ms. Nunez explained this carries out the authority given to the Board on January 1st to cite & fine individuals practicing respiratory care who are not RCPs.

Mr. Mitchell moved to adopt the regulation.

Dr. Sheldon inquired whether other boards were empowered to cite & fine in this manner as well.

Ms. Nunez stated a few boards do have this power such as the Contractor's Board and the Speech Language Pathology Board but most do not current have the power to fine outside of their own licensees.

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

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

Budget Update

Ms. Nunez stated, last July the Board received a letter of accolades from the State and Consumer Services Agency for accurate and timely reporting of the year end financials.

Ms. Nunez informed the Board that since April, 2001, the RCB has gone through reductions in its personnel services budget. The most recent was 12 % in August 2003 which was fully implemented on a permanent basis last week. She explained that means $121,000 was removed from the Board's personnel services budget. Ms. Nunez added, the Board lost 1.9 positions and the overtime budget was eliminated but because of board members' generosity the member per diem was taken away in order to save additional staff from having to be let go. Ms. Nunez stated the good news was the Board is not being prohibited from expending money for those items as long as it is covered by the general expense budget but the Department has cautioned against this. Ms. Nunez asked the Board members to continue to submit their per diem forms for payment consideration as the end of the fiscal year nears. Ms. Nunez added that out-of-state travel is still prohibited.

Dr. Sheldon inquired whether a plan is in place to inform respiratory therapists in the State of California that the Board is acting responsibly directing their energies toward keeping costs down. Ms. Nunez informed the Board that these sacrifices will be addressed in the next newsletter.

Personnel Changes / Impact

Ms. Nunez illustrated to the Board from the diagram in the agenda, that the current staff is highlighted in yellow and the purple represents eliminated positions since April 2001 (including the 1.9 positions recently lost). Overall the Board lost 6 people in the last 2 years.

The Board acknowledged and commended staff for handling the added workload.

Ms. Nunez asked the board members to prioritize the various projects listed in section 8b of the agenda. [See final page of minutes] Collection of Outstanding Costs Ms. Nunez explained, at Mr. Mitchell's request, staff has collected information from the different DCA boards concerning their methods for collecting outstanding costs. She added the passing of AB 1777 gave the board the authority to contract with collection agencies to collect outstanding costs. Knowledge gained from the Contractor's Board (who was ahead of us in this process) helped to guide the RCB into the contract negotiation process with a collection agency. At this point, proposals have been submitted to five different potential contractors and the board is waiting for them to submit bids. Implementation is anticipated for February or March. Ms. Nunez estimated outstanding costs at around one million dollars, Success rates and commission charges vary between collection agencies but the Board hopes to capture $450,000 in outstanding costs initially and about $75,000 annually thereafter.

EXECUTIVE COMMITTEE REPORT
(Scott J. Svonkin, President) Strategic Goals and Objectives - Status
(Larry L. Renner, RCP, Vice-President)

President Svonkin explained that the progress on the strategic plan is updated on an ongoing bases. He added some of the items will need to be prioritized and re-visited next year. He stated unless someone has questions or issues about specific items he would proceed.

Sunset Review Recommendations - Status

President Svonkin opened the discussion concerning staff updates on the status of the Sunset Review Recommendations.

Ms. Nunez explained that little progress has been made on recommendation #2. She added the Board will be before the joint review committee in two years.

President Svonkin requested this item be placed on the next meeting's agenda.

Fiscal Analysis

President Svonkin asked if the Board had questions concerning revenue and expenditures.

Dr. Sheldon inquired whether Ms. Nunez has identified any trends or major problem areas. Ms. Nunez responded that pro-rata, under expenditures, consumes a significant portion of the budget. She added that the Board has no recourse or control over these passed on expenditures.

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

Delivery of Anesthetic Agents via Mechanical Ventilation

Vice President Renner pointed out a letter included in the agenda packet sent to Ms. Nunez and asked if she had any comments. Ms. Nunez stated that the issue is whether the Board feels it is within an RCP scope of practice to administer inhaled anesthetic agents for deep or conscious sedation. She added if so ,the Board may want to clarify its law.

Vice President Renner stated that under the direct supervision of an anesthesiologist, he has used Isoflurane and Sevoflurane and has found it to be an extremely helpful technique for treatment in asthma patients. The Practice Act states that medical gas is permitted but exclusive of general anesthesia. The medical definition of general anesthesia is defined as a compound that produces both a loss of consciousness as well as a loss of sensation. Vice President Renner stated that in his experience patients, under this procedure, do not lose consciousness. He added, when the Practice Act was drafted, it was true that the only way to deliver a general aesthetic was by a gas. The progress with these new types of medications, which are not actually a medical gas but actually a fine vapor, does speak to the Practice Act in relationship to it being referred to an ever changing field and that new techniques and technology will continue to enter into it.

Dr. Sheldon explained this is becoming more and more an issue stating there are concerns within a number of the hospitals with legal and administrative staff trying to establish a protocol. Dr. Sheldon cautions the Board on opening the Practice Act until they know the direction hospital will go with this issue. Dr. Sheldon states, on the other hand, he feels it would be a good idea to get the Practice Act clarified before the issue gets solidified.

Mr. Stern asked for clarification whether this is a proposal to allow RCPs to administer general anesthesia.

Vice President Renner stated the general medical community would consider Isoflurane and Sevoflurane to be general aesthetics. However, in its current proposed application there could be a lot of discussion with regards to whether or not it actually meets that criteria.

Dr. Sheldon stated the question is how this motion is going to be worded.

President Svonkin stated opening up the Practice Act is a major legislative process as opposed to showing RCPs already have the right to do this based on the facts.

Dr. Sheldon suggested that a committee be formed to formulate the precise, appropriate wording as it relates to respiratory care. Dr. Sheldon moved for the Professional Licensing Committee (Larry Renner, Richard Sheldon), along with input from outside experts, to draft proposed language clarifying the delivery of anesthetic agents via mechanical ventilation within the scope of respiratory care to be included with the Board's current proposed legislation. Dr. Sheldon added no use of staff time will be needed for this by the Professional Licensing Committee.

Dr. Sheldon asked past President Winn if he could provide the committee with contacts in respiratory care education. Mr. Winn stated that next week a meeting is being held with the Chief of Anaesthetics at UCSD where this can be addressed.

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

Home Care Action Plan

Vice President Renner and Dr. Sheldon met with colleagues from home care agencies in September and results were positive. Vice President Renner noted that one apparent dilemma was that technology has outstripped legislation adding he would like to work with this group to move forward with any appropriate legislation to make sure the public is protected concerning home care devices or services that should be provided by respiratory care practitioners.

Vice President Renner requested the Board be cognizant of the fact that reimbursements related to home care remain to be a concern. He added the Board should balance its focus between the ability to protect the public while at the same time getting the appropriate reimbursements so that the care is provided by qualified professionals.

Vice President Renner moved that the Board support the proposed action plan and continue working with various agencies making sure home care is delivered in a safe and effective manner.

M/Renner/S/Sheldon

Bob Ackermann thanked Vice President Renner, Dr. Sheldon and staff for a very productive meeting on home care and the issues involved. He restated that reimbursement is a struggle. Home care is dependant on Medicare and MediCal as being the primary funding sources of payment. In these cases, respiratory care is not being reimbursed for the services of the RCP.

Dr. Sheldon expressed his understanding of the financial dilemma this poses to the home care industry and inquires how cite and fine for the unlicensed practice of respiratory care will additionally impact the industry. He questioned whether there was interest in meeting twice a year to continue developing more understanding and direction on solving this issue.

Mr. Ackermann responded, yes, they were interested in continuing to meet and resolve issues. He added they plan to make recommendations to the Board within the next 30 days that will specifically address what unlicensed personnel can and can not do as it relates to oxygen delivery.

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

Polysomnography, Pulmonary Function Testing, Hyperbaric Oxygen Therapy, and Cardiac Catheterization Certification Proposal

Vice President Renner moved to have staff resources be committed to preparing a Sunrise Report for each category, as a result of its research and numerous meetings with interested and affected parties and development of proposed legislation for a period of two years with the Professional Licensing Committee providing updates on its findings and status of the project at each Board meeting for the purpose of ensuring continued support.

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

Ms. Nunez stated that the level of staff involvement will depend upon the outcome of listing priorities.

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

Scholarship/Recruitment

Ms. Stenson reported on the feasibility for scholarships for recruitment purposes stating that due to the state budget situation, the recommendation is to defer this at this time.

President Svonkin asked if the Board had any objections. There were none.

Mandating "Law and Professional Ethics" Course

Ms. Stenson reported on the proposal to mandate an ethics course for respiratory care practitioners.

Dr. Sheldon voluntarily removed himself from the discussion and the vote on this topic.

Ms. Stenson pointed out that option #1 in the recommendations would not provide for any continuing education, whereas option #2, #3 & #4 would.

President Svonkin stated that the AARC and the CSRC has agreed to work together to offer the course initially for $30. President Svonkin asked for a motion to adopt recommendation option #2 (which requires retraining every four years) stating from the communication from the AARC and CSRC combined with his own belief, six years is not frequent enough with the changing dynamics in the field.

Mr. Mitchell moved (for the sake of discussion) to adopt recommendation #2 which proposed a mandated ethics course for all applicants prior to licensure, within two years, and every four years thereafter.

M/Mitchell/S/Cooper

Mr. Mitchell asked Ms. Stenson why the recommendation chosen by the committee was to repeat the course every six years as opposed to four. Ms. Stenson stated the committee recommended #4 (requiring retraining every six years) based on both the financial factor and the uncertainty of the amount of variation in professional ethics over the period of four years.

Mr. Mitchell stated he was not convinced forcing someone to take an ethics course would improve the profession, adding he believes RCPs are dedicated individuals who love what they do and understand the importance to the system.

Ms. Cooper suggested the term "Ethics" throws people off stating, it is professional not personal ethics. She expanded saying the focus is more on professional ethics: the legal practice of respiratory care and the expected behavior practicing within this state surrounding those laws.

President Svonkin stated one of the intentions of the ethics course is to reduce the number of enforcement cases.

Mr. Chaturvedi agreed that every four years is an appropriate cycle for this type of course and believes it will help to reduce the number of enforcement cases. Vice President Renner commended the committee for their work and expressed his concern for the added cost this would impose on the practitioner.

Mr. Mitchell inquired whether this is a requirement for any other board under DCA.

Ms. Nunez stated this is a requirement for one other board (Behavioral Sciences) as it relates to continuing education and added there are other non-health related boards that require it as an exam for licensure.

President Svonkin reviewed the costs for the course as one of required continuing education: prelicense - $30; post-license - $60.

Ms. Stenson added performance measures (licensee feedback & reduction or increase in case load) were included in the recommendation which will be monitored every two years to judge the effectiveness of thecourse requirement.

Ayes: Chaturvedi, Cooper, Mitchell, Svonkin
Nays: Renner, Stenson, Stern
MOTION PASSED

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

Enforcement Statistics

Mr. Mitchell asked if the number of applications received is normal for this fiscal year.

Ms. Nunez stated that the number has actually increased and seems to be affected by the change in educational requirements.

Vice President Renner ask for clarification on the figures presented for Cost Recovery Requested, Awarded and Collected.

Ms. Nunez stated, Cost Recovery Requested comes from certifications submitted by the RCB for cost spent on a case and the Awarded Costs are what the judge or stipulation orders.

Mr. Mitchell added there are some cases where costs are awarded but don't get paid which is the reason for the research into a collection agency.

Vice President Renner requested a line item be added for tracking purposes once collections begin.

Mr. Mitchell agreed that tracking collections on this report will show the effectiveness of the collection process.

Dr. Sheldon inquired why the number of complaints received has increased in the last three years.

Mr. Stern responded, factors affecting this number are the passing of the mandatory reporting bill and a steady increase in the criminal rap sheets received from DOJ as a result of improvements made to their systems (automated database, livescan and advancements to the reporting of information).

In-House Review Guidelines

President Svonkin expressed concerns that the In-House Review Guidelines are used for drug offenses and assault cases. He stated if other board members share these concerns, they can be addressed in future meetings.

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

Mr. Mitchell reviewed the Legislative Report:

2003 Legislation

Bill No.	Status	Board's Position
SB 77-	Held in Senate	Support if Amended
SB 252 -	Signed and Chaptered	Oppose
SB 363 -	Chaptered	Support
AB 751 -	Language may be introduced next year	Watch
AB 803 -	Language may be introduced next year	Watch
AB 1549-	ASM/ approp.	Support
AB1777-	Signed and Chaptered	Support

Discussion and clarification ensued.

2004 Proposed Legislation

Mr. Stern moved to adopt the proposed legislation.

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

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

PLEMS Update

President Svonkin stated PLEMS activities are moving forward on time and with no issues.

PUBLIC COMMENT / ITEMS NOT ON THE AGENDA

Irene Moreno, SEIU: Stated today she heard some distressing things. She went on to say, in California they talk about a nursing shortage, yet there are less than 15, 000 RCPs eligible to practice in this state. The Board can mandate ethics, but doesn't have anybody out there to provide ethics. She would like the Board to take a stronger look at doing things that bring more practitioners into the field.

Dr. Sheldon stated as Medical Director of a school of respiratory care in Southern California, he has participated in many types of recruitment programs to enhance the enrollment of respiratory care students. He asked if she had suggestions for what the Board should do.

Ms. Moreno responded she would provide the Board with a letter of suggestions and clarified she was not stating the Board has done nothing, but that she would like to see a stronger effort.

Dr. Sheldon questioned whether this board is the place to look to for increasing the actual number of therapists.

President Svonkin stated the Board has, in its strategic plan, made a commitment to recruitment. However, with the reduction in budget, staff and the restriction of travel due to the State's budget situation that commitment has become a challenge. President Svonkin added, when funds allow or with the cooperation of organizations that may have resources, the Board would be happy to partner in recruitment efforts at a grass-roots level.

Kent Christoph, UCSD: introduced himself as a new intern from the University of San Diego's Center for Public Interest Law and explained he was there to report on the Board's positions, proposed legislation and pending litigation that affects constituents.

Mark Goldstein, CSRC: complimented and thanked the Board for the ethics course decision calling it a major step to assure quality and added he believes it will help therapists feel they have the backing of the Board to say what is right or wrong when asked to do something.

Bob Bence: complimented the Board on the ethics issue and suggested the Board look into other topics as well, such as the practice of concurrent therapy in respiratory care, stating he believes this to potentially compromise the safety of the public with regards to respiratory care. Mr. Bence stated another area to examine would be a better (less broad) definition of what a Respiratory Care Manager should and should not be in Title 22. Departments are currently being run by people who are not trained respiratory care practitioners.

Vice President Renner stated that question has been posed to the Professional Licensing Committee and the Board has made its position clear that it is not a practice the Board agrees with however at this point in time, the Board does not have the legislative authority to enforce that position.

2004 BOARD MEETINGS

President Svonkin requested consideration that the fall board meeting be scheduled in the same week as the "Respiratory Care Week," the week of the 22nd. Additionally, the Board received a suggestion from the CSRC to meet the week of their meeting (June 24th- 26th in San Diego).

Mr. Mitchell expressed concern with the length of time between this meeting and June and suggested meetings in both March and June, since the Board needs to meet in March for legislative reasons.

Ms. Nunez suggested a conference call might be a better idea for the March meeting as it would require less staff time and resources to prepare.

Vice President Renner stated attendance could be low if a board meeting is scheduled the same time as the Respiratory Care Week due to hospital activities.

Mr. Mitchell moved to schedule a tentative conference call meeting March 26 if a discussion is needed for legislative purposes (as determined by the legislative committee and called by the Board President) and a meeting June 24th in San Diego, with the following meeting October 14 & 15 in Sacramento.

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

FUTURE AGENDA ITEMS

None noted at this time.

ELECTION OF OFFICERS

President
Mr. Mitchell moved to nominate Scott Svonkin for Board President
M/Mitchell/S/Chaturvedi
Ayes: Chaturvedi, Cooper, Sheldon, Svonkin

Ms. Stenson moved to nominated Larry Renner for Board President
M/Stenson/S/Stern
Ayes: Renner, Stenson, Stern

Mr. Svonkin is re-elected Board President.

Vice President
Ms. Stenson moved to nominate Kim Cooper for Vice President
M/Stenson/S/Renner
Ayes: Chaturvedi, Cooper, Renner, Stenson, Svonkin

Dr. Sheldon moved to nominate Larry Renner for Vice President
M/Sheldon/S/Stern
Ayes: Mitchell, Sheldon, Stern

Mr. Mitchell moved to nominate Barbara Stenson for Vice President
Ms. Stenson declined

Ms. Cooper is elected Vice President.

TROOP RECOGNITION

Presentation by Respiratory Care Board; Special Presentations by the Honorable Mike Machado of the California State Senate and the Honorable Lois Wolk of the California State Assembly. Honorees: Matthew A. Petrovich, CRT, RCP, MSgt, USAF; Teddy L. Denison, RRT, RCP, PO2, US Navy; Austin E. DelaCruz Jr., RRT-NPS, RPFT, RCP, TSgt, USAF; Michael C. Hermon, CRT, RCP, SSgt, USAF; Fred T. Maddox II, CRT, RCP, SSgt, USAF; Lisa M. Pickett, RRT, CPFT, RCP, SSgt, USAF; Jeffrey S. Rutherford, CRT, RCP, MSgt, USAF; Daniel L. Severson, RRT, RCP, SCPO, US Navy; Cloria E. Smith, CRT, RCP, TSgt, USAF; Darrell R. Waite, CRT, RCP, TSgt, USAF; Claire L. Zink, CRT, RCP, Sgt, US Army

President Svonkin: Since September eleventh, we have experienced a different dynamic in our country. Nowadays, it doesn't matter if you're a liberal or conservative, there's one thing we all hold to be clear: That the work, people in the military do, is to protect our freedom and our rights. The fact that you're all RCPs means a great deal to the profession. The fact that you're not only serving our country but serving asthmatics and people with COPD, like myself, making sure we're okay and healthy and can move forward with our lives. This week was Veteran's day so this is our way of paying tribute to those that are currently serving and remembering those that we lost. There is that risk that each one of you face in your service: the realities we hear every night in the news. This war has cost us Californian's, American's, men and women, family and friends.

I don't want to take a lot of time but I want to tell you how we got here. The Board unanimously agreed to celebrate the profession and celebrate your good work. It doesn't matter whether you went to Iraq or replaced somebody so they could go to Iraq. The fact is you served our country with distinction and honor and served this profession the same way and we are grateful to you. We wanted to express our appreciation to those of you who are RCPs in the military and we wanted to recognize your good work, your commitment to defend our country and our liberties and to take notice of you.

I'm going to go through and invite each one of you up and present you with just a small token of our esteem and appreciation. This does not represent the breadth and the width of our admiration. Each of you is welcome to say something briefly while we do this. We recognize, you will all tell us that you're doing your job and this is what you signed up for, but the fact is, you're putting yourselves on the line, to be in the military, to serve this country and to take care of people who need RCPs. We're in a very much more dangerous world than we ever were. So what you signed up for has gotten to be very different. We appreciate that you're there.

Following our presentation, Senator Machado will make some comments and recognize those of you who are from his district and Assembly Member Wolk will do the same. While we don't have legislators from each one of your districts, known that there's nobody that's not here because they don't believe in you or that we didn't invite them, it's just that their schedules didn't allow them.

President Svonkin presented certificates of appreciation from the Respiratory Care Board to the following service members:

MATTHEW PETROVICH

President Svonkin: Assembly member Dave Cox, leader of the Republican State Assembly, also wanted me to present to you this certificate of recognition. Matthew is a Master Sergeant in the U.S. Air Force Reserve at Travis Air Force Base. He's been a licensed RCP since 1997. He works full time as an RCP at Sutter Memorial. He's been enlisted for 18 years since 1985, deployed from March through May in Operation Enduring Freedom in 2002. In 2003, he was deployed for 45 days in Iraqi Freedom. While in Iraq and in the surrounding countries, he served as part of a medical team and air transport. He entered active combat zones to retrieve injured troops. He recently became deactivated. We're glad he joined us today. He's been awarded several medals. We hope he'll put this recognition right next to them. Matthew, I want to thank you on behalf of the Board members. We hope you stay in the profession for a long time.

Mr. Petrovich: I'll just take a few seconds. I appreciate the Board honoring myself and the others up here. I'd just like to say if not for Emily's support, Sutter's support, Chief Magilry's support and my children's support, I wouldn't have been able to do it. So when you see the badge or you see the name on the uniform, please remember their families as well.

President Svonkin: While we honor these folks that are in the military for their sacrifices, I also want to commend each of your employers because it takes companies and non-profits to support those of you who are doing work to protect the country. So to those at Sutter, we applaud you too.

MICHAEL HERMON

President Svonkin presented Mr. Hermon with certificates on behalf of the Legislature: Assembly Leader Dave Cox and his office and Assemblyman Tim Wesley.

President Svonkin: Michael Hermon is a Staff Sergeant in the Air Force and is full-time active duty at Travis Air Force Base. He's been a licensed RCP since 2002. We want to thank you for your service to our country and to those who need respiratory care in the State of California.

FRED MADDOX

President Svonkin: Fred is a Sergeant in the U.S Air Force. He's a full time, active duty, licensed RCP since 1995. He enlisted in 1988 and served over 15 years. He is also employed part time at Kaiser Permanente in Richmond. He was deployed to Turkey as a part of Iraqi Freedom on December 7 for four and a half months. His duties include acting as an RCP on a critical care team in a one hundred bed facility. As we said for all of these, we admire you, we applaud you and we appreciate you and we think you men and women represent the best of the profession.

LISA PICKETT

President Svonkin: Lisa Pickett is a Staff Sergeant in the Air Force at Travis Air Force Base. She's full-time active duty and has been an RCP since 1998. Thank you for all your work.

JEFFREY RUTHERFORD

President Svonkin presented Mr. Rutherford with certificates on behalf of the Legislature: Assembly Leader Dave Cox and his office and Assemblyman Tim Wesley.

President Svonkin: Jeffrey Rutherford, CRT, RCP, is a Master Sergeant in the United States Air Force. In appreciation for your dedication as a licensed respiratory care practitioner serving in the United States Armed Forces. In honor of your courage and valor defending our country and our liberties on this the 14th day of November, 2003.

Mr. Rutherford: I want to thank my wife for her support.

Assembly member Tim Wesly is recognizing you for your dedication and service as a respiratory care practitioner serving in the United States Armed Forces. We appreciate it.

DANIEL SEVERSON

President Svonkin: Daniel is a Senior Chief Petty Officer in the U.S. Navy. He is a reservist stationed in Buena Park. He's a licensed RCP since 1996. He's employed full time as an RCP with Long Beach Memorial. He was deployed this summer for two months as a part of Operation Iraqi Freedom. He traveled to Iraq and Kuwait. While there, he was support for guard and briefing personal and evacuation of troops from a tent fire. He was also deployed to the Middle East for operation Nobel Eagle in 2002. For all your work on behalf of the U.S. Navy and on behalf of the California Legislatures and on behalf of the Board, I want to thank you for your service.

DARRELL WAITE

President Svonkin: Darrell is a Staff Sergeant in the U.S. Air Force at Travis Air Force Base. He is a full time active duty, licensed RCP since 1994. Darrell, thank you and keep up the good work.

President Svonkin mentioned four other individuals who could not attend:

CLORIA E. SMITH

CRT, RCP, Staff Sergeant for the U.S Air Force Base in Fairfield, California.

TEDDY DENNISON

Petty Officer in the U.S Navy, stationed in San Diego served in operation Enduring Freedom, licensed since 1993.

CLAIRE ZINK

Sergeant, U.S Army, stationed in Selma. Currently serving in Kosovo.

AUSTIN DELACRUZ

Tech Sergeant, U.S Air Force, RRT-NPS, RPFT, RCP President Svonkin invited Senator Machado to come up and recognize the service members from his district.

Senator Mike Machado: Both Assemblywoman Lois Wolk and myself, have, within our district, Travis Air Force Base. That base is so critical to the gateway to the rest of the world for our armed forces and is critical to our defense. It's very important, because of the make up of the armed forces today, to rely on reservist in addition to those on active duty Working together they carry out the mission.

I would like to, on behalf of myself and Ms. Wolk (who is not here today) acknowledge the tremendous efforts that you gentlemen and women have done and continue to do for the safety of our freedom and support of the values of America.

President Svonkin thanked the service members for being here and being a part of this celebration and asked the board members if they'd like to take this opportunity to say something.

Dr. Sheldon: I just want to say thank you very much.

Mr. Chaturvedi: Thank you all for your service and for all you do for us.

Ms. Cooper: As a military brat, I have a special affinity for those in the service and I've worked at VA hospitals in the past and recently gave up my position at Stanford to work at a VA hospital again. I love working there and I really appreciate you for everything that you're doing. Thank you very much.

Mr. Mitchell: There's always discussion about role models in life and we have a lot of conversations about the occupation of respiratory care therapists. Again, you are all to be commended. You have a difficult job and it looks like you all handle it well. I, and on behalf of my family, appreciate all your efforts.

Mr. Stern: I echo my colleague sentiments and make one other observation. You gentlemen and lady dress so perfectly, unbelievable!

Vice President Renner: I just simply want to thank you for taking the time from your day to be here so we could recognize you.

Ms. Stenson: I say thank you also, and I'm really honored to be here with you.

President Svonkin: I want to make one comment though. Our staff made this, not just a recognition, but a celebration with the decorations. When I asked if we could have a few balloons, I never imagined what an incredible job they would do. It's a testament to the fact that the staff of our board (not just our board members) but the board members, staff and everybody here respect and believe in what you do. We don't do this normally. This is not how our room looks and this is not how our meetings go. I don't know how to impress upon you more but we are really grateful and we hope that the commitment that you have to both our country and our profession will be shared with the people around you and that we'll have more of you the next time we get a chance to honor you. Thank you all.

THE PRIORITY LIST

To help identify how best to direct limited staff resources, Ms. Nunez asked the board members to prioritize the various projects in process (section 8b) and identify the top four. After some discussion and clarification the following list was established:

1. Unlicensed Personnel
2. Ethics
3. Newsletter
4. Home Care

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

ADJOURNMENT

Dr. Sheldon moved that the meeting be adjourned at 2:30 p.m.
M/Sheldon/S/Stern
Unanimous: Chaturvedi, Cooper, Renner, Sheldon, Stenson, Stern, Svonkin
MOTION PASSED