Board Laws and Rules. Steve Hardt, MA, RRT St. Petersburg College

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1 Board Laws and Rules Steve Hardt, MA, RRT St. Petersburg College

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3 No conflicts of interest/professional relationships Not an attorney Not a Board Member

4 Before we start Please turn any cells phones to silent mode. Please feel free to ask any questions as we go.

5 Board rules represent the MINIMAL standard of practice. In many cases the actual standard of care of the profession is much higher. I m the messenger here! My goal here is to explain not to defend

6 Remember CAP, TJC, and AHCA may also have standards not mentioned in the Florida Practice Act

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8 Don t forget Our Board Rule is 468 (which is what we re talking about today) FL Statutes - Title XXXII Chapter 456 Health Professions and Occupations: General Provisions 456 Also imposes requirements on ALL health care practitioners

9 Chapter 64B32-6 (5) beginning with the biennium ending May 31, 2015 a licensee needs, of which (2) credit hours must include Florida laws and rules to bring the licensee up to date on the laws and rules of the Board and the regulatory agency under which the Board operates

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16 Why People are unaware of the existing Law and penalties Recent changes in the law that effect practitioners, and those who supervise them. Practitioners tend to assume they know what s there I suspect the Board gets tired of people saying I didn t know

17 Objectives Review the structure of the Board, as mandated by the CEU requirement Review those section of the Board rules most likely to cause issues Provide 10 practical tips for ensuring compliance with the Board Rules

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20 A few point before we begin I ve excluded anything that is just plain common sense for example, I don t think I needs me to tell them attempting to obtain a license by bribery ( (b)) is apt to cause problems. I m not an attorney, so I ve included the actual board rule in difficult cases

21 What is the Florida Board of Respiratory Care

22 The Florida Board of Respiratory Care was established to ensure that every Respiratory Therapist practicing in this state meets minimum requirements for safe practice. The Florida Board of Respiratory Care through efficient and dedicated organization, will license, monitor, discipline, educate, and when appropriate, rehabilitate practitioners to assure their competence in the service of the people of Florida. Board website accessed at

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24 The Florida Board of Respiratory Care plays a leading role in the ever-changing health care environment through dialogue with the public, the legislature, academia, and the community. The Board consists of seven members appointed by the Governor and confirmed by the Senate. Five members are licensed respiratory therapists and two members are laypersons. Despite the expiration of their term, Board members continue to serve until they have been replaced.

25 Who sits on The State RC Board 7 members An RRT A CRT A RCP from each of these areas RC Education RC Management/Supervision Homecare/sub acute 2 consumer members (must live in Florida and never had been a licensed health care practitioner)

26 The board members Appointed by the Governor Must have been actively engaged in the practice of RC in Florida for at least 4 consecutive years prior to their appointment 2 serve 2 year terms, two serve 3 year terms, 3 serve 4 year terms Limited to 2 consecutive terms Make $50 per day plus travel expenses

27 The board members Elect a chair and a vice chair each year Must meet at least twice a year Need 4 or more present to have a quorum

28 Current Board Members Respiratory Care Members Bayyinah Sherrod, RRT Chair Morfia (Joy) Nunez, CRT Peter Hendriksen, RRT Legislative Liaison vacant Education Liaison Delbert Fields, RRT Budget Liaison Enforcement Liaison Consumer Member Shawnta Friday-Stroud, Ph.D., Vice Chair Vacant Position

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31 Probable cause hearing 64B ) The Board shall enter final orders in disciplinary cases against respiratory therapists. The determination of probable cause to issue an administrative complaint against a respiratory therapist shall be made by the Probable Cause Panel of the Board

32 Probable Cause Panel (Continued) 2) The Chair of the Board shall appoint at least 2 people to the probable cause panel and shall designate it s chair. The appointed people shall be either current Board members or at least one current Board member and one or more former members of the Board. If available, one member of the panel shall be a consumer member and at least one member shall be a licensed member of the profession.

33 Probable cause panel (Continued) 2).With Regards to violations of Part V of chapter 468 ( These board rules) and 456 (Health Professions and Occupations General Provisions).the determination as to whether there is probable cause shall be made by majority vote

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35 What is the Florida Board of Health Respiratory Care Laws and Rules?

36 Respiratory Care laws and Rule Latest edition published in April 2012, prior edition was July pages Largely administrative Better defines qualified practitioner 2 sections Disciplinary Grounds and Actions Injunctive relief

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38 Disciplinary Grounds and Actions Disciplinary Grounds and Actions Section the following acts constitute grounds for a denial of a license or disciplinary action

39 (B) If you lose your license in one state, territory, or country You are probably going to lose it/get it suspended in Florida

40 (C) Being convicted or found guilty of, or entering a plea of nolo contendere to, a crime regardless of adjudication in any jurisdiction which directly relates to respiratory care services or the ability to deliver such services

41 (D) Willfully making or filing a false report or record, or willfully failing to file a report of record, or willfully impeding or obstructing such filing or inducing another person from doing so.

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43 (f) Unprofessional conduct, which includes, but is not limited to, any departure from, or failure to conform to acceptable standards related to the delivery of respiratory care services You re going to be surprised how they define this in later sections. More on this later

44 (g) and (h) Engaging or attempting to engage in the possession, sale, or distribution of controlled substances.. Section H states you can be cited for willfully failing to report a violation of this This is addressed over and over throughout the board rule

45 (i) Violating an order of the Board If the Board orders you to do something, there are huge penalties for failure to comply Not a good thing to play around with

46 (j) and (k) These sections deal with J) practicing on a revoked, suspended, or inactive license K)helping someone else practice without a license

47 (m) And (n) These sections prohibit: m) accepting and performing professional responsibilities which the licensee knows, or has reason to know, she or he is not competent to perform n)delegating responsibilities to someone you know they are not qualified to perform

48 (O) Prohibits gross or repeated malpractice. Defines malpractice as: Failure to deliver respiratory care services with that level of care, skill, and treatment which is recognized by a reasonably prudent RCP or RT with similar training as being acceptable under similar conditions and circumstances

49 Financial impropriety (p),(s), (u) P) prohibits kickbacks S) Soliciting patients through fraud or deception U) financial exploitation of a patient or 3 rd party, including but not limited to the selling of services, goods, appliances, or drugs

50 (Q) Section q specifically states that: A patient is presumed to be incapable of giving free, full, and informed consent to sexual activity with the patient s RCP or RT.

51 (w) Being unable to deliver RT services with reasonable skill and safety by reason of illness or use of alcohol, drugs, narcotics, chemicals, or any other type of material as a result of any mental or physical condition

52 (w) continued In enforcing this paragraph, the department shall, upon probable cause, have authority to compel an RCP to submit to a mental or physical examination by physicians designated by the department. The cost of this exam shall be borne by the licensee being examined

53 (w) continued The failure of the RCP to submit to such an examination when so directed constitutes an admission of the allegations upon which a default and final order may be entered without the taking of testimony or presentation of evidence, unless the failure was due to circumstances beyond his or her control.

54 (w) continued An RCP affected under this paragraph shall at reasonable intervals be afforded an opportunity to demonstrate that she or he can resume the competent delivery of respiratory care In any proceeding under this paragraph, neither the records, nor the orders entered by the Board shall be used against the RCP in any other proceeding

55 The Professionals Resource Network (PRN) Impaired practitioner program here in Florida Private non profit program Covers a wide range of health care workers (nurses have their own program) Broad brush program that includes confidential treatment of physical and mental disorders, substance abuse, chemical dependency and treatment for alleged sexual boundary issues

56 The Professional s Resource Network May require break from practice during initial assessment As Consultant to the Department of Health, Department of Business and Professional Regulation and the Licensing Boards, PRN supports compliant participants who have disciplinary investigations, complaints, or action taken against their license. Participation in PRN is often used as mitigation in disciplinary cases charging impairment and PRN will speak in support of those in compliance. PRN website

57 Penalties This section forbids: License obtained through fraud Unlicensed practice Unauthorized diploma or education programs But please note This section defines any violation of this section as a third degree felony Has a duty to report clause

58 64B Unprofessional conduct This section defines, and provides examples of what the board considers unprofessional conduct, then provides examples The definition is any departure from, or failure to conform to, acceptable standards related to the delivery of respiratory care services This section has a defined duty to report

59 Examples of unprofessional conduct A) Violating the confidentiality of a patient

60 Examples of unprofessional conduct B) falsely misrepresenting the facts on an application for employment as a respiratory therapist

61 Examples of unprofessional conduct C) leaving a respiratory therapy assignment before appropriately advising appropriate supervisory personnel Surprisingly, there are no other requirement listed

62 Examples of unprofessional conduct D) providing false or incorrect information to an employer regarding the status of certification, registration, or licensure

63 Examples of unprofessional conduct E) failing to report another licensee in violation of the laws and/or rules pertaining to the profession This defines a duty to report

64 Unprofessional conduct 64B Foul or abusive language in a patient care or public area

65 HIV/AIDS Knowledge of Antibody status The Board strongly urges all licensees under its jurisdiction who are involved in invasive procedures to undergo testing to determine their HIV status. In the event a licensee tests positive, the licensee must enter and comply with the requirements of the Physicians Recovery Network

66 Also..FS Effective July 1, 2009 The Florida Board of Respiratory Care required to refuse a license if Convicted, plead guilty or no contest to violation of fraud of Social and economic assistance False pretenses or fraud Felony drug abuse Medicare or Medicaid Terminated with cause from Florida Medicaid Any other State Medicaid program or Medicare program

67 Physician Supervision Numerous sections of the rule deal with the requirement for orders and physician supervision Therapy must be ordered by physician or protocol There are license revocations and suspensions on the books because of this

68 Recredentialling after a break As I mentioned earlier, I get a lot of calls at the school, for this. The rule defines in detail, what must be done to reinstate a license. It s quite a pain. I really encourage you to keep your license until you are absolutely sure you won t be needing it

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70 Remember, If fraud is involved, the fine is increased by $10,000 So for example, if you willfully fail to report as required, 1 st offense the fine is $300-1,000 (amongst other penalties) If you fraudulently file a report, the minimum fine is $10,000

71 Guilty of crime directly relating to practice or ability to practice 1 st offense minimum 6 months probation to revocation and fine $ $1,000 2 nd offense court ordered sanctions, from one year suspension to revocation and fine $5,000 to $10,000

72 Willfully failing to file a report as required 1 st offense reprimand to one year suspension, and fine $ $1,000 2 nd offense one year probation with conditions to 1 year suspension and fine $ $3,000 3 rd offense 1 year suspension to revocation and a fine from $3,000 - $10,000

73 Unprofessional Conduct 1 st offense minimum 1 year probation to revocation and fine $ $2,000 2 nd offense 1 year suspension to revocation and fine $2,000 - $10,000

74 Failure to report another licensee in violation 1 st offense letter of concern to 6 months probation, and fine $ $1,000 2 nd offense from 6 months probation to 1 year suspension, and fine $500 to $3, $6,000 3 rd offense from 1 year suspension to revocation and fine and a fine from $3,000 - $10,000

75 Failure to perform legal obligation 1 st offense reprimand to revocation, fine $300-$1,000 2 nd offense 1 year probation to 6 months suspension, fine and fine $ to $5,000 3 rd offense from 1 year suspension to revocation with no ability to reapply, fine $3,000 - $10,000

76 Delegation to professional responsibilities to unqualified person 1 st offense 1 year probation to revocation and fine $300-$1,000 2 nd offense from 6 months suspension followed by year probation to revocation and fine $1,000 - $10,000 3 rd offense from 1 year suspension followed by 2 years probation to revocation with no ability to reapply and a fine from $3,000 - $10,000

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78 Many get the impression that the board will now be involved in a lot of issues that were formerly between employer and employee The duty to report issue will probably be challenging. For what it s worth, these changes may result in more disciplinary action

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80 #1

81 #2 Whatever mistakes you make, the penalties will be far more severe if fraud is involved Be honest, as painful as it may be.

82 #3 Be careful with students. Although mentioned in students may cause issues

83 #4 Watch your temper and your language.

84 #4 The rules on substance abuse/impaired practitioners haven t gotten any more lenient

85 #5 By my interpretation of board rule, you have a duty to report violations. I have no idea how this plays out in practice.

86 #6 If you have a physical or mental issue with could effect your ability to practice, especially if it requires medication, be careful to keep it well managed..

87 #7 Practice and accept assignments only within your level of competence, and make sure the people your supervise do the same

88 #9 Keep your license clean in every state

89 #10 Always check to make sure you meet, in some way, the physician supervision standard People get burned by this Be covered by order or protocol

90 So, you think you have this???? Let s look at a few case scenarios and ask yourself if action could be taken against this RT under the board rules.

91 Scenario #1 Bill is an RT working on the tele floor. He has more treatments than he can count. The charge nurse on the floor has been supervising him, at least in Bill s opinion, a bit to closely. Bill voices his displeasure using language that would make a sailor blush..

92 Scenario #2 Sue is supervising a student. Sue has the student doing some treatments on one floor while she checks the patients on another. The student is caring for a patient on a 6 lpm nasal cannula, but disconnects the cannula to run the nebulizer. The student forgets to reconnect the cannula, and the patient dies an hour later. A investigation discovers the error and rules it was a contributing factor in the patient s death.

93 Scenario #3 Joe and Mike are both RTs. Mike knows for a fact that Joe charts vent checks and treatments without doing them. Mike sees this as Joe s problem and does not report it The hospital investigates how Joe can do so many treatments. As part of the investigation, they talk to Mike

94 Scenario #4 Mary the RT has major knee problems, and the pain often makes it difficult to complete a shift. She takes Percocet to help her through. One night she cannot finish several treatments. One of the treatments she misses is an asthmatic who goes in respiratory failure and ends up on a vent.

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