May 16, 2008

Letter from the CSRC Medical Director

April 24, 2008

Re: SB 1526

To Whom It May Concern:

I am licensed California physician and have 26 years of experience working with patients suffering from sleep disorders/obstructive sleep apnea as a Full Professor of Medicine at the University of California, Davis in the Division of Pulmonary & Critical Care Medicine and have been concerned with the lack of regulation in this field. I am currently the California Society for Respiratory Care Medical Director. I understand that SB 1526 is on the table to address regulation, however I have many concerns. Briefly they are:

1) Regulation by Physicians
In my opinion, it is inappropriate and irresponsible for government to create an unfunded mandate for physicians to oversee a practice that is so clearly tied to respiratory care. While there are 80+ sleep disorders, Obstructive Sleep Apnea is routinely the most common sleep disorder diagnosed and treated. “The therapeutic and diagnostic use of oxygen, the use of positive airway pressure including continuous positive airway pressure (CPAP) and bilevel modalities, and maintenance of nasal and oral airways that do not extend into the trachea” is respiratory care. The American Association for Respiratory Care designated Polysomnography a sub-specialty of respiratory care over 5 years ago. In addition, approximately 4 years ago, the Commission on Accreditation for Allied Health Education Programs established accreditation for polysomnography programs both independently and as “add-on” programs to existing respiratory care programs. A more logical path for any type of regulation should fall under the Respiratory Care Board.

2) Criminal Background Checks
This issue of regulating this field was propelled as a result of a sleep technician (not licensed) who was arrested for sexually molesting several patients. I understand there are other sleep technicians with criminal backgrounds (for heinous crimes) also continuing to practice in the field. SB 1526 proposes to require criminal background checks, however it fails to ensure one clearinghouse, as each employing physician would be responsible only for his/her employees (and potential employees). While most would agree on paper that a person convicted for child molestation would be a bad candidate, there will always be someone who will find it acceptable for whatever reason (took a plea bargain, happened 5 years ago, whatever ‘story’ an applicant would choose to tell). Furthermore, there is no way to draw a line as to what convictions are acceptable and which are not - there will always be extenuating circumstances left for each employing physician to make a determination.

3) Patients Rights & Certification Transparency
SB 1526 provides no mechanism for patients to verify the qualifications or discipline taken against a technician by an employer. A technician who is incompetent, unqualified and/or dangerous (even incidents resulting in patient harm/death), would only be known by his previous employers. Employment checks are not required nor is the person verifying employment rarely going to “slander” a former employee in fear of law suits. In many instances, disparaging information is probably confidential. The public has no access.

4) Care Providers
Currently, to qualify to sit for the RPSGT credentialing examination, a person must have up to 18 months of experience and/or have graduated from an approved education program. With only one education program in the state, this bill fails to address how it will allow people to gain experience. The bill mentions “trainees” in subdivision (e) of section 3575, however there are no requirements set forth (supervision, criminal background checks, education, experience etc...). Currently the American Academy of Sleep Medicine has an 80-hour course that approved employers may provide, and is a good adjunct to an 18-month training course. However, the 80-hour course alone is not sufficient to learn the skills necessary to safely and competently perform “the therapeutic and diagnostic use of oxygen, the use of positive airway pressure including continuous positive airway pressure (CPAP) and bilevel modalities, and maintenance of nasal and oral airways that do not extend into the trachea.” I am concerned that this course will somehow be sufficient to allow a level of independent practice.

5) Supervision by Telephone
Supervision is defined as “a critical watching and directing (as of activities or a course of action).” SB 1526 provides that, supervision “means that the supervising physician and surgeon shall remain available, either in person or through telephonic or electronic means, at the time that the polysomnographic services are provided.” I have concerns that given the definition, using the term supervision is misleading. Further, while SB 1526 does not provide for supervision of trainees, currently, the “trainee” job description of the sleep association provides that a trainee may provide respiratory care under the supervision of a “technician.”

I am glad to see that attention has been given to the need to regulate sleep technicians. However, I believe SB 1526 as written will only perpetuate the disparities and problems that currently exist.

Please contact me at (916) 734-3564 or sylouie@ucdavis.edu if you have any questions or would like to discuss further.

Sincerley,

Samuel Louie, M. D.

Samuel Louie, M. D.
Professor of Medicine
Director, Pulmonary Services Laboratory
DIrector, Department of Respiratory Care
Division of Pulmonary & Critical Care Medicine
Department of Internal Medicine