Probation

Probation Program Objectives
The Board is required to operate an effective and proactive enforcement program to adhere to its mandate. After Board members have adopted a final decision where "probation" is ordered, the case is referred to the Probation Program.

A central aspect of the Board's program is to maintain continual contact with probationers to ensure that conditions of probation are met and minimize potential patient harm. The purpose is NOT for the Board to rehabilitate those persons placed on probation. Probation is a privilege afforded by the Board to provide the probationer the opportunity to rehabilitate and/or establish a support system within an individual's community to prevent relapses.

Objectives for the Probation Program include:

Actively enforcing the Board's mandate to protect and serve the consumer by administering and enforcing the Respiratory Care Practice Act and its regulations in the interest of the safe practice of respiratory care by:

• Preventing dangerous and/or incompetent respiratory care practitioners [RCPs] from delivering health care to the public;
• Monitoring probationers with alcohol and substance abuse histories in a very precise, meticulous, and accurate manner;
• Restricting and monitoring the practice of RCPs who have committed acts which indicate they may be incompetent or unable to practice safely, and
• Fully adhering to the Resolution relating to probation adopted by the Board in 1993
• Operating an efficient, cost-effective probation monitoring program.

1. Terms/Conditions of Probation
2. Forms

The Board's disciplinary guidelines included in the California Code of Regulations, by reference, are used to determine appropriate discipline and include language for terms and conditions of probation, which is subject to modification on a case-by-case basis.

The "Standard Conditions" are generally imposed in all probationary orders. The terms and conditions classified as "Specialty Conditions" are only imposed as part of the order if the cause for action warrants such. A general description of each term and condition follows.

STANDARD CONDITIONS
Obey All Laws
Quarterly Reports
Probation Monitoring Program
Probation Monitoring Costs
Employment Requirement
Notice to Employer
Changes of Employment or Residence
Cost Recovery
Tolling for Out-of-State Residence or Practice
Valid License Status
Violation of Probation
Completion of Probation

STANDARD CONDITIONS INVOLVING ALCOHOL OR DRUGS
Standard Conditions listed above and
Work Schedules
Biological Fluid Testing
Abstention from Use of Mood Altering Substances

SPECIALTY CONDITIONS
Supervisor Quarterly Reports of Performance
Restriction of Practice
Direct Supervision
Additional Continuing Education
Education/Course Work
Statute and Regulation Examination
Suspension
Alcohol and Drug Treatment
Competency Examination
Psychological Evaluation
Physical Examination

OBEY ALL LAWS
This is a standard condition and should appear in all probationary orders. Any act, arrest, citation, filing of charges, conviction of ANY law or any violation of the regulations governing the practice of respiratory care is a violation of law AND probation. Most orders require that the probationer advise the Board, in writing, of any arrest, filing of charges, issuance of citation, etc., within 14 days from such an act.

QUARTERLY REPORTS
This condition requires probationers to file Quarterly Report of Compliance forms with the Board on the following quarterly reporting schedule for each year of probation:

Reporting Period	Due Between
July 1 - September 30	October 1 - October 7
October 1 - December 31	January 1 - January 7
January 1 - March 31	April 1 - April 7
April 1 - June 30	July 1 - July 7

Failure to file complete and timely reports is a violation of probation.

PROBATION MONITORING PROGRAM
This condition provides that the probationer shall comply with requirements of the Board appointed probation monitoring program, and shall, upon reasonable request, report to a local venue as directed.

Probationers are required to claim all certified mail issued by the Board, respond to all notices of reasonable requests timely, appear for meetings or scheduled exams, appear to provide a specimen (if subject to testing), submit in advance and on a continuous basis copies of work schedules, and submit Annual Reports, Identification Update reports, or other reports similar in nature, as requested by the Board or its representative.

PROBATION MONITORING COSTS
This standard condition requires reimbursement for actual expenses incurred to monitor the terms and conditions of probation. Currently, costs can be as low $100 per month. Collecting costs from those individuals that incur the expenses prevents other licensees in good standing from having to pay for such programs. Further, the filing of bankruptcy by a probationer does not relieve him/her of his/her responsibility to reimburse the Board for these costs.

EMPLOYMENT REQUIREMENT
This condition requires a probationer to maintain employment [a minimum of 24 hours/wk] as a respiratory care practitioner for two thirds of his/her probationary period. If the probationer fails to meet this requirement he/she must take a competency examination before an unrestricted license is issued and is responsible for the costs associated with the examination [See Competency Examination for more information]

NOTICE TO EMPLOYER
This condition generally requires:

• each place of employment advise the Board, in writing that he/she is aware that his/her employee is on probation with the Board and that he/she has received a copy of the disciplinary pleadings filed against the probationer. This must usually be done prior to the commencement of or return to work. The Board requests that each employer/supervisor complete an Employer Acknowledgment form.
• if the probationer is employed by or through a registry, he/she make each hospital or establishment to which he/she is sent aware of the discipline imposed by providing his/her direct supervisor and administrator at the hospital or establishment with a copy of the disciplinary pleadings filed against the probationer prior to beginning employment. Each supervisor and administrator must complete an Employer Acknowledgment form and submit it directly to the Board.

CHANGES OF EMPLOYMENT OR RESIDENCE
This condition will either require that the probationer notify the Board, in writing of any changes in employment AND residence or may only require changes in employment, within a given period of time. Probationers must report to the Board in writing all employers whether related to respiratory care or not.

Regardless of whether the term and condition requires notification of changes in residence, California Code of Regulations, section 1399.304 requires every person holding a license to file, in writing, with the Board his/her proper and current mailing address within 14 days of any such change. Therefore, a violation of this regulation would also be a violation of the "Obey All Laws" term and condition of probation.

This condition will usually state that PO Boxes are not acceptable. However, the Board will accept the PO box for a mailing address but must also receive a physical address. Changes in employment include but are not limited to, changes in supervisors, directors, location, telephone numbers, new employment, termination of employment, or any other significant changes.

COST RECOVERY
This standard condition requires reimbursement for actual expenses incurred for the investigation and prosecution of the case. These costs must, usually, be paid in equal quarterly installments during the first year of probation. However, it is critical that the monitor refer to the disciplinary order to clarify amounts and when costs are actually due.

Collecting costs from those individuals that incur the expenses prevents other licensees in good standing from having to pay for isolated expenses. Further, the filing of bankruptcy by a probationer does not relieve him/her of his/her responsibility to reimburse the Board for these costs.

TOLLING FOR OUT-OF-STATE RESIDENCE OR PRACTICE
This term and condition generally provides that for periods of residency or practice outside California, whether the periods of residency or practice are temporary or permanent, will toll the probation period but will not toll the cost recovery requirement, or the probation monitoring costs incurred.

Travel/or change of residence out of California for more than 30 days must be reported to the Board in writing prior to departure. And notification of returning to California must be done in writing within 14 days upon his/her return to California AND prior to the commencement of any employment where representation as a respiratory care practitioner is/was provided.

VALID LICENSE STATUS
This condition requires the probationer to maintain a valid license for the duration of probation. The probationer is to complete all required continuing education units required to renew his/her license, and submit complete and timely renewal applications.

VIOLATION OF PROBATION
This term and condition should state that any violation of any term and condition is grounds for revocation of probation and carrying out the order that was stayed (i.e. denial, revocation). Further this term and condition should provide that if an Accusation and/or Petition to Revoke Probation has been filed, the Board shall have continuing jurisdiction over the case and the period of probation shall be extended until the matter is final.

COMPLETION OF PROBATION
This term and condition should state that upon successful completion of probation, the probationer's license will be fully restored.

WORK SCHEDULES
This term is generally ordered when the probationer is subject to biological fluid testing and abstention. It requires the practitioner to ensure his/her work schedule is submitted to the Board at ALL times. Generally, work schedules are provided by facsimile on a monthly basis. Any changes to a work schedule are to be reported immediately on the work schedule telephone hotline.

BIOLOGICAL FLUID TESTING
Biological Fluid Testing is generally ordered if the probationer's crime or cause for discipline involved alcohol or drugs. Probationers are subject to providing a specimen at any time as directed by the Board or the drug screening program approved by the Board. Currently, the Board collects, urine, blood, and hair specimens. A probationer's failure to provide a specimen when directed is a SERIOUS violation of probation.

Whenever possible, the Board shall attempt to collect specimens on a random basis. Random testing for these purposes is defined as the collection of specimens on a continuous basis without any pattern in the dates those specimens are collected and with no notice provided to the probationer. A probationer may be requested to submit to test at any time including at the probationer's work site. Therefore, work schedules are REQUIRED and must be submitted in advance and on a continuous basis.

If a probationer is directed to provide a specimen while at work and his/her time is restricted, the probationer will be permitted to return to his/her patients, as patient care is never to be jeopardized. However, the probation monitor(s) will contact the probationer's supervisor to discuss possible coverage of another therapist for the probationer. If the probationer cannot be released, the monitor may then accompany the probationer to the work area or, with the supervisor, director, human resources or other appropriate approval, accompany the probationer to a restricted work area until such time as the probationer is able to provide a specimen acceptable to the Board. This is the only way to ensure integrity of the specimen collection.

There are several methods to test for the use of controlled or mood altering substances and alcohol. Currently, the Board relies heavily upon urine specimens to test probationers. However, other methods are employed from time to time, which require blood and hair specimen collections. Probationers are responsible for the costs of all testing.

ABSTENTION FROM USE OF ANY AND ALL MOOD ALTERING SUBSTANCES
Abstention from Use of Any And All Mood Altering Substances is generally ordered when the cause for discipline in some way involved alcohol or drugs. The best way for the Board to determine a probationer's abstention is to test him/her as provided in the probationary order. A subsequent conviction of a crime involving mood altering substances is also evidence of a probationer's failure to abstain.

POSITIVE DRUG TESTS
Upon receipt of positive test results and once it has been determined that a probationer has used a mood altering substance, without a proper prescription, any employer(s) will be notified and the case will be referred to the Office of the Attorney General, within 24 hours, requesting either an Interim Suspension Order and/or an Expedited Hearing.

Justification for an Interim Suspension Order includes that the probationer poses an immediate threat to the health, safety and welfare of the public. Such an order, if issued, will suspend a practitioner's license and is generally processed in less than two weeks. The probationer is then prohibited from practicing respiratory care until the matter is resolved. If the request for an Interim Suspension Order is denied, the Office of the Attorney General will diligently work to request a hearing as soon as possible. This will generally occur within two months.

SUPERVISOR QUARTERLY REPORTS OF PERFORMANCE
This specialty conditions requires that each probationer ensure that the supervisor or administrator at each place of employment submit Supervisor Quarterly Report of Performance forms DIRECTLY to the Board for every year of probation as follows:

Reporting Period	Due Between
July 1 - September 30	October 1 - October 7
October 1 - December 31	January 1 - January 7
January 1 - March 31	April 1 - April 7
April 1 - June 30	July 1 - July 7

RESTRICTION OF PRACTICE
There are a number of restrictions that may be placed on a probationary license including restrictions from:

Working in certain types of situations (i.e. home care, registry)
Working with certain types of patients (i.e. children, elderly)
Working in home care, unless under direct supervision and personal observation
Working in or functioning in a supervisory or management capacity [this includes lead responsibilities]

The restrictions are usually placed on the license for the duration of probation, but in some instances, a given period of time is ordered. In some instances the probationer may in addition, be required to notify the Board in writing of how she/he intends and will be able to uphold the restrictions, and receive approval from the Board prior to commencing work.

DIRECT SUPERVISION
This term and condition requires a probationer to work under the direct supervision of a person holding a current and valid non-restricted Respiratory Care Board of California license, for a specified period of time. Under direct supervision is defined as the probationer being assigned to a respiratory care practitioner who is on duty and immediately available in the assigned patient area. When this term and condition is pled, it usually includes that either the supervisor or probationer notify the Board, in writing, of the level of supervision that will be provided to the probationer while she/he is functioning as a practitioner and that the level of supervision must be approved by the Board prior to the commencement of work.

ADDITIONAL CONTINUING EDUCATION
This term and condition requires the completion of continuing education courses, in an area of study that may be specified. Unless otherwise specified, all additional Continuing Education ordered must be in addition to the education required for license renewal. Repeating or using the same course for credit is not acceptable. Additional continuing education must meet the same requirements as continuing education for license renewal unless otherwise specified in the order. Approved courses are noted in the California Code of Regulations, section 1399.351 and criteria for other acceptable courses is found in section 1399.352. The probationer will be required to show proof of completion of the additional continuing education upon completion. Course Hour Courses that meet the approved criteria have established the number of hours the course earns. As a rule of thumb, instruction for one hour [including a 10 minute break for each hour] counts as one hour of continuing education. However, the entire course must be completed to earn the hours. Course providers will not generally give partial credit for partial attendance.

EDUCATION/COURSE WORK
This term and condition usually requires additional education in a specified area of study. Courses generally must be submitted for approval and must be taken at a Board approved institution. The probationer will be required to provide proof of completion, usually in the form of a transcript.

Semester Units vs. Hours vs. Quarter Units Defined
A 3 semester, 3 hour, or 4 quarter unit class generally consists of 45 hours of instruction (2 ½ hours per week x 18 weeks). Courses consisting of 45 or more hours will be accepted as a 3 semester, 3 hour or 4 quarter unit class. As long as the course consists of a minimum of 45 hours of instruction, the duration in which that instruction is received is not relevant (i.e. 50 hours in 2 weeks, 50 hours in 9 weeks, 50 hours in 18 weeks).

STATUTE AND REGULATION EXAMINATION
In most cases, the Statute/Regulation Examination must be taken and passed within six months of the effective date of probation and the probationer is required to pay the current examination fee. As of January 2001, the current fee for the examination is $50. Each probationer must pay for the examination prior to its administration.

Candidates will be provided at least 10 days notice of the scheduled examination date. Prior to the administration of the examination, the probationer will be provided Statute/Regulation Examination Study Materials. Additional hard copies of the study materials are available for $10/set. Study materials include:

Respiratory Care Board Disciplinary Guidelines
Business and Profession Code - General Provisions
Laws and Regulations Relating to the Practice of Respiratory Care
Clinical Laboratory Testing Emergency Regulations (R-40-94)

There are 50 questions and one hour is allowed for completion of the examination. Examination results will be mailed to the probationer within 30 days. Passing scores are 30 or more correct responses.

If a probationer fails the Statute/Regulation examination on the first attempt, he/she will be offered the examination one additional time. The probationer must submit the examination fee for each scheduled examination. Failure to appear for any scheduled examination is a violation of probation.

SUSPENSION
In most cases, suspension is ordered from the effective date of the decision or the date the probationer returns from any employment leave, for a specified number of days/months. If the probationer is not employed as an RCP, the suspension may be effective upon obtaining such employment. If the probationer is employed as an RCP with more than one employer, the suspension affects all employment unless the order specifies otherwise. The probationer is responsible for ensuring a Suspension Certification form is completed and submitted to the Board within 7 days from the completion of the suspension period.

ALCOHOL AND DRUG TREATMENT
A recognized and established alcohol and drug treatment program must be approved by the Board. An alcohol and drug treatment program does NOT solely consist of support groups such as 12-step programs. Rather, approved treatment programs generally include a 12-step program as a small part of its regime. Generally, an established program consists of several group meetings and at least one, one-on-one counseling session each week. Programs must include biological fluid testing and must be willing to report those results, as well as other information to the Board on a regular basis. There are generally other requirements of this term and condition and the order should be carefully read for absolute clarification.

COMPETENCY EXAMINATION
In most cases, the competency exam must taken and passed within six months from the effective date of probation.

PSYCHOLOGICAL EVALUATION
When a psychological evaluation is included in the probationary order, it generally must be completed within 6 months from the effective date and is paid for by the respondent. The examination is to be completed by a psychiatrist or psychologist appointed by the Board. Upon receipt of the psychological evaluation from the appointed evaluator, recommendations that may affect the probationer's ability to practice respiratory care in a safe and professional manner are reviewed and addressed.

PHYSICAL EXAMINATION
As the Disciplinary Guidelines note, a physical examination if ordered, will generally be ordered within 45 days from the effective date of the decision, by a physician appointed by the Board.

Upon receipt of a physical examination report from the approved/appointed physician, recommendations that may affect the probationer's ability to practice respiratory care in a safe and professional manner are reviewed and addressed.