FINAL

The July meeting of the New Jersey State Board of Respiratory Care was convened in accordance with its notice to the Secretary of State, the Bergen Record, the Trenton Times, the Courier Post and the Star-Ledger and was conducted in accordance with the provisions of the Open Public Meetings Act.

Chairman, Capek convened the meeting at 10:00 a.m. A roll call was taken and the following attendance was recorded for these minutes.

PRESENT:

Jeffrey Brozoski Kenneth Capek
Michael G. Brown James Brophy
Janet Castronovo

ABSENT: Robert Malovany, M.D.

Also in attendance: Dorcas K. O’Neal, Executive Director, Tobey Palan, Deputy Attorney and Bernadette Abercrombie, staff.

Public attendance: Joseph Goss, Nancy D’Ambrosio, Director of Respiratory Care, ALLCARE MEDICAL and Eric J. Adams, Director of Respiratory Services, ALLIED HEALTH CARE SERVICES, Inc.

I. APPROVAL OF MINUTES

The Board reviewed the Public Session Minutes of June 3, 2008. On a motion by James Brophy, seconded by Janet Castronovo, the Board unanimously approved the Public Session Minutes as redacted.

II. OLD BUSINESS/REAGENDIZED

a. I/M/O Life Support Technologies, Inc.- An Anonymous letter alleging Life-Support Technologies Inc., (LST) is operating hyperbaric facilities in New Jersey hospitals. The website of LST indicates it will furnish a hospital with the equipment and (personnel nurse manager and certified technician) necessary to assist the facility with its existing chronic wound and hyperbaric medicine program. This matter was reagendized.

I. E-mail from Chairman Capek, with draft response to this anonymous letter to be sent to hospitals. Reagendized.

III. NEW BUSINESS

a. The Board reviewed Respiratory Care Total Revenues for April 2008, as informational.

b. The Board of Respiratory Care reviewed a letter of invitation to Dorcas K. O’Neal, Executive Director, from the NBRC, to attend the 2008 meeting of the State Licensure Liaison Group, sponsored by the NBRC and the American Association for Respiratory Care (AARC). On a motion by James Brophy, seconded by Janet Castronovo, the Board unanimously approved Dorcas K. O’Neal, Executive Director, to attend the State Licensure Liaison Group meeting. On a motion by James Brophy, seconded by Janet Castronovo, the Board unanimously approved Jeffrey Brozoski, Board member, to attend the State Licensure Liaison Group meeting.

c. "Spelling it Out Symposium - The Board reviewed an article regarding NBRC specialty examination to be launched 2009, as informational.

d. The Board reviewed a fax from Brandi Handel, MSN, RN, Robert Wood Johnson Hospital, inquiring as to whether a clinical care technician who recently obtain her respiratory therapist license can continue to work as a clinical care technician and whether she would be held to the respiratory therapist standards even though she would on be able to function within the limited scope of the clinical care technician possible. The Board determined that DAG Palan will contact Ms. Handel to advise of State regulations as it relates to respiratory care.

e. The Board reviewed a fax from Antoine Johnson, Manager, Ancillary Contraction, inquiring as to whether it is true that a respiratory practitioner must visit a patient within 24 hours of delivery of equipment; whether it must be a respiratory therapist to do the visit or can it be a registered Nurse or LPN, whether a durable medical equipment supplier not based in the State of New Jersey but dispenses respiratory equipment within New Jersey is bound by the same law or are the exempt. DAG, Plan, will call Mr. Johnson. For the record, pursuant to N.J.S.A.45:14E-9c, nothing in this act is intended to limit, preclude or otherwise interfere with the practices of other persons and health providers licensed by appropriate agencies of the State of New Jersey, provided such duties are consistent with the accepted standards of the member’s profession and if the member does not present himself as a respiratory care practitioner.

IV. INFORMATIONAL/FYI

None.

VI. LEGISLATION/REGULATIONS

a - b. The Board reviewed a Proposed (Draft) AUGUST, 2008 Delegation and Continuing Education, including the draft from Chaiman, Capek, with Maryann Sheehan, Regulatory Analyst.

The Board discussed amending N.J.A.C. 13:44F-3.3 to read that a licensed respiratory care practitioner may disassemble, clean, disinfect and/or sterilize, assemble and deliver respiratory equipment. The Board discussed deleting N.J.A.C. 13:44F-3.3(d)f in its entirety.

The Board also discussed allowing licensees to obtain continuing education credit for the following activities: successfully completing advanced credentialing examinations approved by the American Association for Respiratory Care (AARC) and the National Board for Respiratory Care (NBRC); successful completion of a competency examination administered by a healthcare institution; and successful completion of a presentation in a healthcare institution with a performance-based competency examination, which includes procedure demonstration The Board will continue discussion of whether N.J.A.C. 13:44F-10.2 should be amended to include these new sources of continuing education. REAGENDIZED.

c. Adopted New Rules: N.J.A.C. 13:45B-2.9,5.2,13.7 and 13.8 -Uncertified and Unlicensed Individuals; Information for Patient/Employers. Summary of Agency-Initiated Changes Upon Adoption: N.J.S.A. 34:8-79 requires that a employment agency, consulting firm or health care service firm, which sends uncertified or unlicensed individual to a patient/employer’s home provide, among other things, written notification be in writing the individual is not certified or licensed. As proposed, N.J.A.C. 13:45B-2.9, 5.2 and 14.8 did not require that notification be in writing. In order to comply with statutory requirements, the Director is changing N.J.A.C. 13:45A2.9, 5.2 and 14.8 upon adoption to require that notification be in writing. Effective April 21, 2008, the Department recodified N.J.A.C. 13:45B-14 as 13:45B-13, therefore, this recodification is applied to adopted new N.J.A.C.13:45B-14.7 and 14.8 (see 40N.J.R.91(b), 2118(a).) This matter is reagendized.

PUBLIC COMMENTS

a. Presentation by Nancy D’Ambrosio, RRT, NPS, Director of Respiratory Care Therapy, Allcare Medical, and Eric Adams, B.A., R.R. T., Director of Respiratory Care, Allied Health Care Services, Inc., regarding delegation by a respiratory care practitioner to unlicensed persons.

Ms. D’Ambrosio stated that the concern in Home Care is patient safety and to use therapists in an efficient way. Providers do not want to delegate patient care to unlicensed persons but there is a shortage of therapists. Home care is about equipment. One of the manufacture of CPAP and BIPAP, had a recall which effected a large number of patients. Providers had to swap equipment and had to delegate it to a trained technician, but all were set by a therapist. Ms. D’Ambrosio stated that technicians check concentrators.

Ms. D’Ambrosio stated that machines were originally set by therapists before delivery. She stated that technicians go through a formal training, go out with a therapist a few times and have competency checks. All equipment technicians who deliver equipment to patients must do a competency check list for that equipment.

Mr. Adams stated that competency is required by Joint Commission on Certification and also guidelines of competency by the AARC. He stated that his company has only 4 therapists to cover 40 patients on ventilators. A technician may clean and deliver the equipment and a therapist will set it, in house with a doctor’s current prescription. He stated that ventilators, CPAP and BIPAP are delivered by a therapists.

Mr. Adams stated that if a technician is taken away from cleaning and delivering equipment, a therapist will have to do it and there is a shortage of therapists. Students are told to first work in a hospital for 2 years because they will be exposed to trauma and develop more skills. Home care therapists work on their own. They have to be very capable.

Ms. D’Ambrosio stated that a technician duties in her company are: swapping, maintaining inventory and cleaning equipment. A technicians will deliver concentrators and educate but not connect to the patient. She stated that the technicians deliver suction units and nebulizers. The technicians do not deliver medication with nebulizers but teach the patient the use of it.

Technicians do not do initial set up of CPAP, BIPAP and nebulizers. That is strictly the job of a therapist. Therapists are mostly women who do not want to deliver equipment that weighs over 30 - 120 lbs. It takes 2 technicians to deliver it based on weight and size.

Mr. Adams stated that a lot of equipment is delivered with tanks full and weigh about 160 lbs.

An ALS patient may be on a trach or a ventilator, or BIPAP. Before the equipment goes out, a therapist signs off on it. A technician will keep track charting it and it has to be maintained. The technician will also chart hours and log with a special number. CPAP’s are usually used for sleep apnea patients. A vent patient is given a number to call the therapist directly. A therapist who has a patient for 20 years can develop a close bond.

Mr. Adams stated that the Joint Commission shows up at places of business un- announced, every 18-39 months to enforce policies.

Mr. Adams stated that liquid oxygen is done at the warehouse but some companies do it on a truck.

Ms. D’Ambrosio stated that a patient who comes out of the hospital, during the 24 hours, a therapist will be sent out. A package is left with the patient with lectures, bill of rights, instructions on how to maintain the equipment and provided a phone number.

Chairman, Capek, thanked them for coming to make the presentation. He stated that the Board’s primary concern is patient care.

VI. OTHER BUSINESS

None.

There being no other business to come before the Board in Public Session, on a motion by James Brophy, seconded by Jeffrey Brozoski, the meeting was adjourned and the Board moved into Executive Session for the purpose of receiving counsel, to conduct two investigative inquiries to review three items of old business and one application.

The Board reconvened in public Session. The next scheduled meeting is August 5, 2008. There being no other business to come before the Board, on a motion by Michael G. Brown, seconded by Janet Castronovo, the Board adjourned the meeting at 5:00 p.m.

Respectfully submitted,

Dorcas K. O’Neal
Executive Director

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