The Vermont Statutes Online

Title 26: Professions and Occupations

Chapter 91: RESPIRATORY CARE

§ 4701. Definitions

As used in this chapter:

(1) "Advisor" means an advisor appointed to give advice to the director of the office of professional regulation under section 4705 of this title.

(2) "Consultation by telecommunications" means a respiratory care practitioner renders professional or expert opinion or advice via telecommunications or computer technology from another location. The term includes the transfer of data or exchange of educational or related information by any means of audio, video, or data communications.

(3) "Direct supervision" means a respiratory care practitioner licensed in this state is physically present and is immediately available to direct and supervise tasks related to patient management.

(4) "Director" means the director of the office of professional regulation.

(5) "Disciplinary action" includes any action taken by the director or by an administrative law officer established by 3 V.S.A. § 129(j) against a respiratory care practitioner or applicant premised on a finding that he or she has engaged in unprofessional conduct. The term includes all sanctions of any kind, refusing to grant or renew licensure, suspending or revoking licensure, and issuing warnings, reprimands, administrative penalties, and conditions.

(6) "Indirect supervision" means a respiratory care practitioner licensed in this state is immediately available for consultation, direction, or supervision regarding the practice or performance of respiratory care.

(7) "Performance of respiratory care" means respiratory care in accordance with the prescription of a licensed physician, licensed osteopath, certified physician assistant, certified anesthesiologist assistant, or licensed nurse practitioner, including the diagnostic and therapeutic use of the following:

(A) Medical gases (except for the purpose of anesthesia), aerosols, and humidification.

(B) Pharmacologic agents.

(C) Mechanical or physiological ventilatory support.

(D) Bronchopulmonary hygiene.

(E) Cardiopulmonary resuscitation.

(F) Insertion and maintenance of artificial airways.

(G) Specific diagnostic and testing techniques employed in the medical management of patients to assist in diagnosis, monitoring, treatment, and research of pulmonary abnormalities, including measurements of ventilatory volumes, pressures, and flows, collection and analysis of specimens of blood and blood gases and specimens from the respiratory tract, expired and inspired gas samples, respiratory secretions, and pulmonary function testing and hemodynamic and other related physiologic measurements of the cardiopulmonary system.

(H) Insertion and maintenance of arterial and venous catheters.

(8) "Practice of respiratory care" means:

(A) Direct and indirect respiratory care services, including the administration of pharmacologic, diagnostic, and therapeutic agents necessary to implement a treatment, disease prevention, pulmonary rehabilitative, or diagnostic regimen by a licensed physician, physician assistant, anesthesiologist assistant, or nurse practitioner.

(B) Transcription and implementation of written or verbal orders of a licensed physician, physician assistant, anesthesiologist assistant, or nurse practitioner which pertains to the practice of respiratory care.

(C) Observing and monitoring signs and symptoms, general behavior, general physical response to respiratory care treatment and diagnostic testing, including determination of whether such signs, symptoms, reactions, behavior, or general response exhibits abnormal characteristics.

(D) Implementing report, referral, and respiratory care protocols or changes in treatment, based on observed abnormalities, pursuant to a physician, physician assistant, anesthesiologist assistant, or nurse practitioner's prescription.

(E) Initiating emergency procedures pursuant to rules adopted by the director or as otherwise provided under this chapter.

(F) Respiratory care may be practiced in any clinic, hospital, skilled nursing facility, private dwelling, or other place deemed appropriate or necessary by the director and in accordance with the prescription or verbal orders of a licensed physician, physician assistant, anesthesiologist assistant, or nurse practitioner.

(9) "Respiratory care" means the allied health profession responsible for the treatment, management, diagnostic testing, control, and care of patients with deficiencies and abnormalities associated with cardiopulmonary systems under the direction of a physician, physician assistant, anesthesiologist assistant, or nurse practitioner. Respiratory care also includes inhalation therapy and respiratory therapy.

(10) "Respiratory care educational program" means a program accredited by the committee on accreditation for respiratory care (CoARC) or by the commission on accreditation of allied health education programs (CAAHEP), or their successor organizations. To qualify for the student respiratory therapist's license, the applicant must be actively enrolled, and in good standing, in a program accredited by one of the agencies listed in this subdivision.

(11) "Respiratory care practitioner" means a person:

(A) Employed in the practice or performance of respiratory care who has the knowledge and skill necessary to administer the functions defined in subdivision (8) of this section.

(B) Capable of serving as a resource in relation to the clinical and technical aspects of respiratory care as to the safe and effective methods for administering respiratory care modalities.

(C) Able to function in situations of unsupervised patient contact requiring individual judgment.

(D) Capable of supervising, directing, or teaching less skilled personnel in the provision of respiratory care services.

(12) "Supervisor of record" means a respiratory care practitioner licensed in this state who has been practicing actively as a respiratory care practitioner for at least two years prior to becoming a supervisor of record and is employed by the same employer as the person being supervised. (Added 2003, No. 139 (Adj. Sess.), § 2.)

§ 4702. Prohibition; offenses

(a) No person shall practice or attempt to practice respiratory care or hold himself or herself out as being able to do so in this state without first having obtained a license.

(b) No person shall use in connection with the person's name any letters, words, or insignia indicating or implying that the person is a respiratory care practitioner unless licensed in accordance with this chapter.

(c) No person shall practice or attempt to practice respiratory care while his or her license has been revoked or suspended.

(d) A person who violates a provision of this section shall be subject to the penalties provided in 3 V.S.A. § 127(c). (Added 2003, No. 139 (Adj. Sess.), § 2; amended 2005, No. 148 (Adj. Sess.), § 50; 2007, No. 29, § 74.)

§ 4703. Professional identification

(a) A person holding a license to practice respiratory care in this state shall use the title "respiratory care practitioner" and the abbreviation "R.C.P."

(b) A licensee shall show his or her license when requested.

(c) A person matriculated in an accredited respiratory education program shall use the title "student respiratory therapist" and the abbreviation "S.R.T."  (Added 2003, No. 139 (Adj. Sess.), § 2.)

§ 4704. Director of the office of professional regulation; duties

(a) The director shall:

(1) Provide general information to applicants for licensure as respiratory care practitioners.

(2) Administer fees as provided for under 3 V.S.A. § 125(b).

(3) Explain appeal procedures to respiratory care practitioners and applicants and explain complaint procedures to the public.

(4) Receive applications for licensure, license applicants under this chapter, and renew licenses.

(5) Refer all disciplinary matters to an administrative law officer.

(6) Revoke, suspend, reinstate, or condition licenses as ordered by an administrative law officer.

(7) Issue reprimands or impose administrative penalties as ordered by an administrative law officer.

(b) The director of the office of professional regulation, with the advice of the advisor appointees, may adopt rules necessary to perform the duties provided under this chapter. (Added 2003, No. 139 (Adj. Sess.), § 2.)

§ 4705. Advisor appointees

(a) The secretary of state shall appoint two respiratory care practi=-tioners to serve as advisors in matters relating to respiratory care. They shall be appointed for staggered five-year terms and serve at the pleasure of the secretary. One of the initial appointments shall be for less than a five-year term.

(b) Each appointee shall have at least three years of experience as a respiratory care practitioner during the period immediately preceding appointment and shall be actively practicing respiratory care in Vermont and remain in good standing during incumbency.

(c) The director shall seek the advice of the respiratory care practi=-tioners appointed under this section in carrying out the provisions of this chapter. These appointees shall be entitled to compensation and necessary expenses in the amounts provided in 32 V.S.A. § 1010 for attendance at any meeting called by the director for this purpose. (Added 2003, No. 139 (Adj. Sess.), § 2; amended 2005, No. 27, § 114.)

§ 4706. Application

To apply for licensure as a respiratory care practitioner, a person shall apply to the director on a form furnished by the director. The application shall be accompanied by payment of the specified fee and evidence of eligibility as requested by the director. (Added 2003, No. 139 (Adj. Sess.), § 2.)

§ 4707. Eligibility

To be eligible for licensure as a respiratory care practitioner, an applicant shall:

(1) have completed a respiratory care educational program as defined in subdivision 4701(10) of this title; and

(2) pass a standardized national examination approved by the director. (Added 2003, No. 139 (Adj. Sess.), § 2; amended 2007, No. 163 (Adj. Sess.), § 43.)

§ 4708. Examination

Examinations shall be conducted under this chapter by a nationally recognized credentialing body approved by the director. Examinations administered and the procedures of administration shall be fair and reasonable and shall be designed and implemented to ensure that all applicants are granted licensure if they demonstrate that they possess the minimal occupational qualifications which are necessary for the protection of the public health, safety, and welfare. The examination shall not be designed or implemented for the purpose of limiting the number of licensees. The director may authorize the use of independent testing services or other services to assist in the administration of examinations. (Added 2003, No. 139 (Adj. Sess.), § 2.)

§ 4709. Licensure without examination; endorsement

(a) The director may issue a license to practice respiratory care by endorsement and without examination to an applicant who is currently licensed to practice respiratory care under the laws of another state, territory, or country, and who is in good standing to practice respiratory care in that jurisdiction, and, in the opinion of the director, the standards and qualifications required for regulation of respiratory care in that state or territory are currently at least equal to those required by this chapter.

(b) An applicant for licensure by endorsement may practice under the indirect supervision and responsibility of a licensed respiratory care practitioner in this state, providing the applicant obtains a temporary license and the following are met:

(1) A current supervisor of record form is on file with the director.

(2) The application is complete except the director may be waiting for validation of out-of-state licenses. (Added 2003, No. 139 (Adj. Sess.), § 2.)

§ 4710. Temporary licensure

(a) A temporary license without examination for practice under the direction of a respiratory care practitioner licensed in Vermont may be issued to a person who applies for the first time to practice respiratory care in this state as a respiratory care practitioner and meets all other qualifications of section 4707 of this title.

(b) A temporary license may be issued only for the purpose of allowing a qualified applicant to practice as a respiratory care practitioner until:

(1) The applicant takes the next examination provided by the director and a determination is made of the applicant's qualification to practice in this state.

(2) The necessary data for licensure without examination are collected and ruled on by the director.

(c) Temporary licenses shall be issued on payment of the specified fee for a fixed period of time to be determined by the director by rule and shall not be renewed, except by petitioning the director, subject to proof of an exceptional cause shown by the applicant. (Added 2003, No. 139 (Adj. Sess.), § 2.)

§ 4711. Temporary licensure for student respiratory therapists

(a) Respiratory care services may be performed without a license by a student currently enrolled in a respiratory care educational program when these services are incidental to the clinical aspect of a student's course of study.

(b) A student enrolled in a respiratory care educational program who is employed in an organized health care system shall apply for a temporary student license from the director prior to performing respiratory care services. Students who have obtained a temporary license may render respiratory care services only under the direct supervision of a licensed respiratory care practitioner for a limited period of time and under conditions specified by the director by rule. The scope of practice of the student respiratory therapist is limited to those activities for which there is documented evidence of competency. (Added 2003, No. 139 (Adj. Sess.), § 2.)

§ 4712. Exemptions from licensure

(a) No person shall practice respiratory care or represent himself or herself to be a respiratory care practitioner unless he or she is licensed under this chapter, except that this chapter shall not prohibit:

(1) A person matriculated in an education program approved by the board who is pursuing a degree in respiratory care or respiratory therapy from satisfying supervised clinical education requirements related to the person's respiratory care education while under direct supervision of a respiratory care practitioner or physician.

(2) A respiratory care practitioner from practicing in the United States Armed Services, United States Public Health Services, or the Department of Veterans' Affairs, pursuant to federal regulations of health care providers.

(3) A respiratory care practitioner who is licensed in another jurisdiction of the United States from providing consultation by telecommunications.

(4) A respiratory care practitioner who is licensed in another jurisdiction of the United States, or foreign educated respiratory care practitioner credentialed in another country, from practicing respiratory care in conjunction with teaching or participating in an educational seminar of no more than 60 days in a calendar year.

(5) Those individuals meeting the aide/assistant classification or those working under medical supervision in a pulmonary function testing or research facility.

(6) Respiratory care rendered in an emergency.

(7) Self care by a patient or gratuitous care by family members or friends who do not represent themselves as respiratory care practitioners.

(8) A respiratory care practitioner who is licensed in another jurisdiction of the United States or a foreign educated respiratory care practitioner credentialed in another country from practicing respiratory care in conjunction with the interfacility transport of a critically ill patient.

(9) A home care medical equipment dealer from performing services related to delivery, setup, instruction, or maintenance of durable medical equipment, including home respiratory equipment. This exemption does not include therapeutic evaluation or assessment.

(10) Expired.]

(11) A polysomnographic technologist, technician, or trainee from performing activities within the scope of practice adopted by the association of polysomnographic technologists, while under the direction of a Vermont licensed physician who has training in sleep medicine.

(12) A perfusionist from performing those activities contained within the perfusion scope of practice adopted by the American Society of Extracorporeal Technologists, or its successor organization, while under the supervision of a licensed physician.

(b) This chapter does not restrict a person licensed or certified under any other law of this state from engaging in the profession or practice for which that person is licensed or certified if that person does not represent, imply, or claim that he or she is a respiratory care practitioner or a provider of respiratory care. This chapter does not expand the scope of practice of any other profession or occupation referred to in this chapter. (Added 2003, No. 139 (Adj. Sess.), § 2.)

§ 4713. Renewals; continuing education

(a) Licenses shall be renewed every two years upon payment of the required fee, provided the person applying for renewal completes at least 12 hours of continuing education requirements, approved by the director, during the preceding two-year period.

(b) The director, with the advice of the advisor appointees, shall establish, by rule, guidelines and criteria for continuing education credit.

(c) Biennially, the director shall forward a renewal form to each licensee. Upon receipt of the completed form, renewal fee, and evidence of eligibility, the director shall issue a new license.

(d) Any application for renewal of a license which has expired shall be accompanied by the renewal fee and late fee. A person shall not be required to pay renewal fees for years during which the license was lapsed.

(e) If a respiratory care practitioner's license has lapsed for more than five consecutive years, that person shall pay all applicable renewal and reinstatement fees and shall demonstrate competence to the director's satisfaction by one or more of the following, as determined by the director:

(1) documenting licensed practice in another state;

(2) completing a remedial course;

(3) completing continuing education requirements; or

(4) passing an examination approved by the director. (Added 2003, No. 139 (Adj. Sess.), § 2; amended 2005, No. 27, § 115; 2007, No. 163 (Adj. Sess.), § 44.)

§ 4714. Unprofessional conduct

(a) A person licensed under this chapter or a person applying for a license shall not engage in unprofessional conduct.

(b) Unprofessional conduct means the following conduct in addition to the conduct set forth in 3 V.S.A.§ 129a:

(1) Failure to keep written respiratory care records justifying a course of treatment for a patient, including patient history, examination results, and test results.

(2) Performing professional services which have not been authorized by the patient or his or her legal representative.

(3) Performing any procedure or prescribing any therapy which, by the prevailing standards of respiratory care practice, would constitute experimentation on a human subject without first obtaining full, informed written consent.

(4) Sexual harassment of a patient.

(5) Engaging in a sexual act as defined in 13 V.S.A. § 3251 with a patient under the care of the person licensed under this chapter.

(c) In connection with a disciplinary action, the office of professional regulation may refuse to accept the return of a license tendered by the subject of a disciplinary investigation.

(d) The burden of proof in a disciplinary action shall be on the state to show by a preponderance of the evidence that the person has engaged in unprofessional conduct.

(e) After hearing and upon a finding of unprofessional conduct or upon approval of a negotiated agreement, an administrative law officer may take disciplinary action against the licensee or applicant. That action may include any of the following conditions or restrictions which may be in addition to or in lieu of a warning, reprimand, administrative penalty, suspension, or revocation:

(1) A requirement that the person submit to care or counseling.

(2) A restriction that a licensee practice only under supervision of a named individual or an individual with specified credentials.

(3) A requirement that a licensee participate in continuing education as directed by the administrative law officer in order to overcome specified deficiencies.

(4) A requirement that the licensee's scope of practice be restricted to a specified extent.

(f) The administrative law officer may reinstate a revoked license on terms and conditions he or she deems proper. (Added 2003, No. 139 (Adj. Sess.), § 2.)

§ 4715. Repealed. 2007, No. 163 (Adj. Sess.), § 45.