To repeal section 334.735, RSMo 1994, and section 334.740, RSMo Supp. 1995, relating to the regulation and licensing of respiratory care practitioners, and to enact in lieu thereof sixteen new sections relating to the same subject, with penalty provisions.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF MISSOURI, AS FOLLOWS:

Section A. Section 334.735, RSMo 1994, and section 334.740, RSMo Supp. 1995, are repealed and sixteen new sections enacted in lieu thereof, to be known as sections 334.735, 334.740, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, and 14, to read as follows:

334.735. As used in sections 334.735 to 334.748, the following terms mean:

(1) "Applicant", any individual who seeks to become a registered health care professional in one of the following health care professions: occupational therapist[,] or physician assistant[, or respiratory care practitioner];

(2) "Certificate of registration", a document issued to an applicant by the department acknowledging that the applicant has been entered on the register of individuals successfully completing the requirements of a certifying entity, and is entitled to practice in the health care profession for which the certificate applies;

(3) "Certification" or "registration", a process by a certifying entity that grants recognition to applicants meeting predetermined qualifications specified by that certifying entity;

(4) "Certifying entity", the nongovernmental agency or association which certifies or registers individuals who have completed academic and training requirements;

(5) "Department", the department of economic development or a designated agency thereof;

(6) "Occupational therapist", one engaged in the use of purposeful activity with individuals who are limited in their ability to function by physical injury or illness, psychosocial dysfunction, developmental or learning disabilities, poverty and cultural differences or the aging process in order to maximize independence, prevent disability and maintain health. The practice encompasses evaluation, treatment and consultation. Specific occupational therapy services include: teaching daily living skills; developing perceptual motor skills and sensory integrative functioning; developing vocational and prevocational capacities; designing, fabricating, or applying selected orthotic and prosthetic devices or selective adaptive equipment; specifically designed manual, creative, prevocational activities and exercises to enhance functional performance; administering and interpreting tests such as manual muscle and range of motion; and adaptive environments for the handicapped. The services may be provided individually, in groups, or through social systems;

(7) "Physician assistant", one engaged in the examination or treatment of patients while under the supervision, control and responsibility of a licensed physician.

(a) The scope of practice of a physician assistant shall consist only of the following services and procedures:

a. Taking patient histories;

b. Performing physical examinations of a patient;

c. Performing or assisting in the performance of routine office laboratory and patient screening procedures;

d. Performing routine therapeutic procedures;

e. Recording diagnostic impressions and evaluating situations calling for attention of a physician to institute treatment procedures;

f. Instructing and counseling patients regarding mental and physical health using procedures reviewed and approved by a licensed physician;

g. Assisting the supervising physician in institutional settings, including reviewing of treatment plans, ordering of tests and diagnostic laboratory and radiological services, and ordering of therapies, using procedures reviewed and approved by a licensed physician;

h. Assisting in surgery;

i. Performing such other tasks not prohibited by law under the supervision of a licensed physician as the physician's assistant has been trained and is proficient to perform;

(b) Physician assistants shall not prescribe nor dispense any drug, medicine, device or therapy independent of consultation with the supervising physician, nor prescribe lenses, prisms or contact lenses for the aid, relief or correction of vision or the measurement of visual power or visual efficiency of the human eye, nor administer or monitor general or regional block anesthesia during diagnostic tests, surgery or obstetric procedures;

(c) A physician assistant shall clearly identify himself or herself as a physician assistant and shall not use or permit to be used in [his] the physician assistant's behalf the terms "doctor", "Dr." or "doc" nor hold himself or herself out in any way to be a physician or surgeon. No physician assistant shall practice or attempt to practice in any location where the supervising physician is not immediately available for consultation, assistance and intervention, except in an emergency situation, nor shall any physician assistant bill a patient independently or directly for any services or procedure by the physician assistant;

(d) The physician assistant shall be a person who is a graduate of a physician assistant program accredited by the [Committee on Allied Health, Education and Accreditation of the American Medical Association] Commission for the Accreditation of Allied Health Education Programs or its successor or is certified by a national nongovernmental agency or association, has passed the national commission on certification of physician assistants examination and has been certified by the national commission on certification of physician assistants or its successor. A person who has been employed as a physician assistant for three years prior to August 28, 1989, and has passed the national commission on certification of physician assistants examination shall be deemed to have met the academic requirements necessary for registration or certification;

(e) For purposes of this section, the registration of physician assistants shall take place within processes established by the state board of registration for the healing arts through rule and regulation. The board of healing arts is authorized to establish rules and regulations establishing registration and renewal procedures, fees, and addressing such other matters as are necessary to protect the public and discipline the profession. An application for registration may be denied or the registration of a physician assistant may be suspended or revoked by the board in the same manner and for violation of the standards as set forth by section 334.100, or such other standards of conduct set by the board by rule or regulation. Persons licensed [under] pursuant to the provisions of chapter 335, RSMo, shall not be required to register as physicians assistants;

(8) "Recognition", the formal process of becoming a certifying entity as required by the provisions of sections 334.735 to 334.743;

(9) ["Respiratory care practitioner", one engaged in the therapeutic and diagnostic use of medical gases, administering apparatus, humidification and aerosols, administering of drugs and medications to the cardiorespiratory systems under protocols established by the supervising physician, ventilatory assistance and ventilatory control, postural drainage, percussion, vibration, and breathing exercises, cardiopulmonary rehabilitation, cardiopulmonary resuscitation and maintenance of natural airways, as well as the insertion and maintenance of artificial airways. The practice of respiratory care shall also include specific testing techniques employed in respiratory therapy to assist in diagnosis, monitoring, treatment and research; including, but not limited to measurements of ventilatory volumes, pressures and flows, specimen collection of blood and other materials, pulmonary function, testing and hemodynamic and other related physiological monitoring of the cardiopulmonary systems. The practice of respiratory care is not limited to the hospital setting;

(10)] "Supervision", control exercised over a physician assistant working within the same office facility of the supervising physician except a physician assistant may make follow-up patient examinations in hospitals, nursing homes and correctional facilities, each such examination being reviewed, approved and signed by the supervising physician.

334.740. 1. No person shall hold himself or herself out to the public by any title or description including the words registered occupational therapist, registered physician assistant[,] or physician assistant as defined in section 334.735[, or registered respiratory care practitioner] unless the person is duly registered under the provisions of sections 334.735 to 334.748, if for that profession a certifying entity has been recognized by the department.

2. Nothing in sections 334.735 to 334.748 shall be construed as prohibiting any individual whether registered pursuant to sections 334.735 to 334.748 or not from providing the services of occupational therapist[,] or physician assistant[, or respiratory care practitioner].

3. Nothing in sections 334.735 to 334.748 shall be construed as prohibiting credentialed assistants from providing services under the supervision of the same health care professional who is registered in accordance with sections 334.735 to 334.748.

4. Any person found guilty of violating any provision of subsections 1 to 3 of this section is guilty of an infraction and upon conviction thereof shall be punished as provided by law. For purposes of this subsection, the maximum fine for a violation hereunder shall be one thousand dollars.

Section 1. 1. Sections 1 to 14 of this act shall be known and may be cited as the "Respiratory Care Practice Act".

2. For the purposes of sections 1 to 14 of this act, the following terms mean:

(1) "Board", the Missouri board for respiratory care, established in section 4 of this act;

(2) "Certified respiratory therapy technician" or "CRTT", a person meeting entry level qualifying educational requirements, having passed the certification examination and having been certified by the certifying entity;

(3) "Certifying entity", the cognitive competency testing organization as authorized by the board;

(4) "Continuing education", the offering of instruction or information to license holders for the purpose of maintaining or increasing skills necessary for the safe and competent practice of respiratory care;

(5) "CRTT" and "RRT", abbreviation for certified respiratory therapy technician and registered respiratory therapist and are registered trademarks of a certifying entity of the National Board for Respiratory Care;

(6) "Direct clinical supervision", availability of a licensed respiratory care practitioner for purposes of immediate communication and consultation with, and the assistance of, the permit holder;

(7) "Division", the division of professional registration of the department of economic development;

(8) "Practice of respiratory care", as provided in section 2 of this act;

(9) "Protocol", a written agreement of medical care plan delegating professional responsibilities to a person who is qualified by training, competency, experience or licensure to perform such responsibilities. A protocol is a defined response to a specific clinical situation and shall be written, signed and dated by a physician prior to its implementation;

(10) "Registered respiratory therapist" or "RRT", a person meeting advanced-level qualifying professional educational requirements, having passed the registry examination and having been registered by the certifying entity;

(11) "Respiratory care", the allied health profession whose practitioners function under the supervision of a physician or in accordance with clinical protocols accepted by the physician in the administration of pharmacologic, diagnostic and therapeutic agents related to respiratory care necessary to implement or modify diagnostic regimes, treatment, disease prevention or pulmonary rehabilitation of patients with deficiencies and abnormalities associated with the cardiopulmonary system;

(12) "Respiratory care practitioner", a person:

(a) Duly licensed by the board;

(b) Employed in the practice of respiratory care who has the knowledge and skill necessary to administer respiratory care as defined in this section;

(c) Who is able to function in situations of unsupervised patient contact requiring individual judgment; and

(d) Who is capable of serving as a resource to the physician in relation to the technical aspects of respiratory care as to safe and effective methods for administering respiratory care modalities;

(13) "Special training":

(a) Is a deliberate systematic educational activity in the affective, psychomotor and cognitive domains;

(b) Is intended to develop new proficiencies with an application in mind;

(c) Is presented with an attention to needs, objectives, activities and a defined means of evaluation.

Section 2. 1. The "practice of respiratory care" includes, but is not limited to:

(1) The administration of pharmacologic, diagnostic and therapeutic agents related to respiratory care to implement a disease prevention, diagnostic, treatment or pulmonary rehabilitative regimen prescribed by a physician or by clinical protocols pertaining to the practice of respiratory care;

(2) Observing, examining, monitoring, assessment and evaluation of signs, symptoms and general physical response to respiratory care procedures, including whether such are abnormal, and implementation of changes in procedures based on observed abnormalities, appropriate clinical protocols or pursuant to a prescription by a physician licensed under chapter 334, RSMo, or a person acting under a collaborative practice agreement as authorized by section 334.104, RSMo; or

(3) The initiation of emergency procedures under the regulations of the board or as otherwise permitted in sections 1 to 14 of this act.

2. The practice of respiratory care is not limited to the hospital setting but shall always be performed under the prescription, order or protocol of a licensed physician and includes the diagnostic and therapeutic use of the following:

(1) Administration of medical gases, except for the purpose of anesthesia;

(2) Administration of pharmacologic agents related to, or in conjunction with, respiratory care procedures;

(3) Aerosolized medications and humidification;

(4) Arterial blood gas puncture or sample collection;

(5) Bronchopulmonary hygiene;

(6) Cardiopulmonary resuscitation;

(7) Environmental control mechanisms and therapy;

(8) Initiation, monitoring, modification of ventilator controls, and discontinuance or withdrawal of continuous mechanical ventilation;

(9) Intubation/extubation of endotracheal tubes, tracheostomy tubes and transtracheal catheters;

(10) Insertion of artificial airways and the maintenance of natural and artificial airways;

(11) Mechanical or physiological ventilatory support;

(12) Point-of- care diagnostic testing;

(13) Specific diagnostic and testing techniques employed in the medical management of patients to assist in diagnosis, monitoring, treatment and research of pulmonary abnormalities, including measurement of ventilatory volumes, pressures, flows, collection of specimens of blood and mucus, measurement and reporting of blood gases, expired and inspired gas samples and pulmonary function testing;

(14) Diagnostic monitoring or therapeutic intervention for oxygen desaturation, aberrant ventilatory patterns and related sleep disorders including obstructive and central apnea; and

(15) Other related physiologic measurements of the cardiopulmonary system.

3. The practice of respiratory care may also include, with special training, the following:

(1) Insertion and maintenance of peripheral arterial or venous lines and hemodynamic monitoring;

(2) Assistance with diagnostic or performing therapeutic bronchoscopy;

(3) Extracorporeal Membrane Oxygenation (ECMO), limited to the intensive care setting, and delivered under the supervision of a Certified Clinical Perfusionist (CCP, as defined by the American Board of Cardiovascular Perfusion, an allied medical professional whose expertise is the science of extracorporeal life support) and a licensed physician;

(4) Air or ground ambulance transport;

(5) Hyperbaric oxygenation therapy;

(6) Electrophysiologic monitoring; or

(7) Other diagnostic testing or special procedures.

4. The state board of registration for the healing arts pursuant to section 334.125, RSMo, and the board of respiratory care, created pursuant to section 4 of this act, may jointly promulgate rules defining additional procedures recognized as proper to be performed by respiratory care practitioners. In order to take effect, such rules shall be approved by a majority vote of a quorum of each board. Neither the state board of registration for the healing arts nor the board of respiratory care may separately promulgate rules relating to the practice of respiratory care.

Section 3. 1. No person in the state of Missouri, unless such person holds a current and valid license issued pursuant to sections 1 to 14 of this act, shall:

(1) Provide the services of a respiratory care practitioner;

(2) Represent himself or herself as, or hold himself or herself out, to the public by any title or description including the words, respiratory therapist, respiratory therapy technician, or inhalation therapist, or as having any similar description;

(3) Advertise as, or take any action that would imply or lead the public to believe that such person is, a legitimate provider of respiratory care.

2. Nothing in sections 1 to 14 of this act shall be construed to authorize or permit a respiratory care practitioner to practice medicine.

Section 4. 1. There is hereby created within the division of professional registration a board to be known as the "Missouri Board for Respiratory Care". The board shall consist of seven members, all of whom shall be citizens of the United States, eighteen years of age or older and residents and registered voters of the state of Missouri for at least one year. The governor shall appoint the members of the board with the advice and consent of the senate for terms of three years except as provided in subsection 2 of this section. No more than four members on the board may be from the same political party. No member of the board shall serve more than two consecutive three-year terms. The members of the boards shall consist of one physician, one public member, one hospital administrator and four respiratory care practitioners.

2. The terms of the first board shall be:

(1) The physician and one registered respiratory therapist for one year;

(2) The public member, the certified respiratory therapy technician and one registered respiratory therapist for two years; and

(3) The hospital administrator and one registered respiratory therapist for three years.

3. The physician member of the board shall be licensed pursuant to chapter 334, RSMo, have an interest and knowledge in the diagnosis and treatment of the deficiencies, abnormalities and diseases of the cardiopulmonary or respiratory systems.

4. The public member of the board shall be a registered voter and a person who is not, and never has been, a member of the profession regulated by the provisions of sections 1 to 14 of this act, or the spouse of any such person; and a person who does not have and never has had a material financial interest in either the providing of the professional services regulated by the provisions of sections 1 to 14 of this act or an activity or organization directly related to the profession regulated pursuant to sections 1 to 14 of this act. The duty of the public member shall not include the determination of the technical requirements to be met for licensure or whether any person meets such technical requirements or the technical competence or technical judgment of a licensee or a candidate for licensure.

5. The hospital administrator member shall be employed as a hospital administrator in this state.

6. The certified respiratory therapy technician and registered respiratory therapists shall each have at least five years of active experience as a provider or teacher of respiratory care as the person's principal livelihood and shall be licensed, or in the case of the first board, registered, with the state of Missouri as a respiratory care practitioner.

7. Any member of the board may be removed from the board by the governor for neglect of duty required by law, for incompetency, or for unethical or dishonest conduct. Upon the death, resignation, disqualification or removal of any member of the board, the governor shall appoint a successor, within sixty calendar days after the vacancy occurs, to fill the vacancy for the remainder of the unexpired term.

Section 5. 1. The board shall elect annually a chairperson, vice chairperson and a secretary from among its members. In even-numbered years, the chairperson shall be elected from the respiratory care members and the vice chairperson from the nonrespiratory care members and in

odd- numbered years the chairperson shall be from nonrespiratory care members and the vice chairperson from the respiratory care members.

2. The board shall adopt, implement, rescind, amend and administer such rules and regulations as may be necessary to carry out the provisions of sections 1 to 14 of this act, including, but not limited to, rules relating to professional conduct, continuing education requirements for renewal of licenses, approval or sanction of continuing education programs, the amount of continuing education hours required and to the establishment of ethical standards of practice for persons holding a license or permit to practice respiratory care in this state. The board shall meet with the division at least twice a year and advise the division on matters within the scope of sections 1 to 14 of this act. The board may convene at the request of the chairperson or as the board may determine for such other meetings as may be necessary. A presence of a majority of the members of the board constitutes a quorum at any meeting.

3. Each member of the board shall receive as compensation, an amount set by the division not to exceed fifty dollars per day, for each day devoted to the affairs of the board and may be reimbursed for actual and necessary expenses incurred in the performance of the member's official duties.

Section 6. The division of professional registration through the department of economic development shall provide all necessary personnel to carry out the provisions of sections 1 to 14 of this act. The division shall:

(1) Exercise all budgeting, purchasing, reporting and other related management functions;

(2) Establish application and licensure fees, in cooperation with the board, and collect such fees;

(3) Deposit all fees collected pursuant to sections 1 to 14 of this act in a "Respiratory Care Practitioners Fund", which is hereby created. Notwithstanding the provisions of section 33.080, RSMo, to the contrary, money in this fund shall not be transferred and placed to the credit of general revenue until the amount in the fund at the end of the biennium exceeds two times the amount of the appropriations from the fund for the preceding fiscal year, or three times the amount if the board requires renewal of licenses less often than annually. The amount, if any, in the fund which shall lapse is that amount in the fund which exceeds the appropriate multiple of the appropriations from the fund for the preceding fiscal year;

(4) Process applications and notify licensees when a license is to expire;

(5) Establish the amount the board shall receive as per diem for each day devoted to the member's official duties on the board and reimburse any actual and necessary expenses a board member incurs in the performance of the member's official duties;

(6) Promulgate, in cooperation with the board, such rules and regulations as are necessary to administer the provisions of sections 1 to 14 of this act.

Section 7. 1. No rule or portion of a rule promulgated under the authority of sections 1 to 14 of this act shall become effective until it has been approved by the joint committee on administrative rules in accordance with the procedures provided in this section, and the delegation of the legislative authority to enact law by the adoption of such rules is dependent upon the power of the joint committee on administrative rules to review and suspend rules pending ratification by the senate and the house of representatives as provided in this section.

2. Upon filing any proposed rule with the secretary of state the filing agency shall concurrently submit such proposed rule to the committee which may hold hearings upon any proposed rule or portion thereof at any time.

3. A final order of rulemaking shall not be filed with the secretary of state until thirty days after such final order of rulemaking has been received by the committee. The committee may hold one or more hearings upon such final order of rulemaking during the thirty- day period. If the committee does not disapprove such order of rulemaking within the thirty-day period, the filing agency may file such order of rulemaking with the secretary of state and the order of rulemaking shall be deemed approved.

4. The committee may, by majority vote of the members, suspend the order of rulemaking or portion thereof by action taken prior to the filing of the final order of rulemaking only for one or more of the following grounds:

(1) An absence of statutory authority for the proposed rule;

(2) An emergency relating to public health, safety or welfare;

(3) The proposed rule is in conflict with state law;

(4) A substantial change in circumstance since enactment of the law upon which the proposed rule is based.

5. If the committee disapproves any rule or portion thereof, the filing agency shall not file such disapproved portion of any rule with the secretary of state and the secretary of state shall not publish in the Missouri Register any final order of rulemaking containing the disapproved portion.

6. If the committee disapproves any rule or portion thereof, the committee shall report its findings to the senate and the house of representatives. No rule or portion thereof disapproved by the committee shall take effect so long as the senate and the house of representatives ratify the act of the joint committee by resolution adopted in each house within thirty legislative days after such rule or portion thereof has been disapproved by the joint committee.

7. Upon adoption of a rule as provided in this section, any such rule or portion thereof may be suspended or revoked by the general assembly either by bill or, pursuant to section 8, article IV of the Constitution of Missouri, by concurrent resolution upon recommendation of the joint committee on administrative rules. The committee shall be authorized to hold hearings and make recommendations pursuant to the provisions of section 536.037, RSMo. The secretary of state shall publish in the Missouri Register, as soon as practicable, notice of the suspension or revocation.

Section 8. An applicant for a license to practice respiratory care may be issued a license which is valid until the expiration date as determined by the board after the following requirements have been met:

(1) The applicant submits to the board:

(a) A completed application for licensure;

(b) Written evidence of:

a. Credentials from the certifying entity; or

b. Current licensure or registration as a respiratory care practitioner in another state, the District of Columbia or territory of the United States which requires standards for licensure or registration determined by the board to be equivalent to, or exceed, the requirements for licensure under sections 1 to 14 of this act;

(c) Payment of any required fees;

(2) The board requests and receives a complete background check and other information as may be deemed necessary to fulfill sections 1 to 12 of this act.

Section 9. 1. A license issued pursuant to sections 1 to 14 of this act shall be renewed annually, except as provided in sections 1 to 14 of this act. The board shall mail a notice to each person licensed during the preceding licensing period at least thirty calendar days prior to the expiration date of the license.

2. A respiratory care practitioner may choose not to renew such person's license and allow such practitioner's licensure to lapse, or may ask to be put on inactive status, provided such person does not practice respiratory care during such period that the licensure is lapsed or the practitioner is on inactive status. If the person desires to resume the practice of respiratory care, the person must apply for licensure under the licensing requirements in effect at the time the person applies to resume the practice of respiratory care. If the person wants to maintain such person's licensure on an inactive status and in order to avoid an administrative revocation of such license, the person shall pay the required fee as established by the board for maintaining an inactive license.

Section 10. 1. If an applicant submits an application and provides documentation that the person is enrolled in a nationally accredited respiratory care educational program and the board completes a background check, an applicant may be issued a temporary permit to practice respiratory care for a period during the applicant's course of study and up to a period of twelve months after the date the applicant graduates from the program. If the holder of a temporary permit issued pursuant to this subsection discontinues coursework in the program prior to graduation, such holder's temporary permit shall be automatically revoked. If a temporary permit expires or if on the effective date of this section, a person has graduated from a program but has not met all the requirements for licensure as a respiratory care practitioner, the board may issue an extension of the temporary permit to practice respiratory care for an additional period, not to exceed twelve months, if such person applies for an extension.

2. The board may issue a one-time temporary permit to practice respiratory care for a period of eighteen months from the date the person applies. Such temporary permit shall terminate at the end of the eighteen-month period, or at the time the holder of such temporary permit applies for a temporary educational permit issued pursuant to subsection 1 of this section. The board may issue the temporary permit provided by this subsection if:

(1) The applicant submits an application to the board and pays the required fees and:

(a) Is a veteran of the United States military services and such applicant has a minimum of six months respiratory care experience as a member of the military and such experience is verified; or

(b) Has a minimum of six months respiratory care experience in a United States territory or foreign country; and

(c) Such applicant has been performing the duties of a respiratory care practitioner, as defined in section 1 of this act, for the previous twelve months; and

(2) The board completes a background check.

3. The board may issue a one-time temporary permit to practice respiratory care for a period of eighteen months from the date the person applies. Such temporary permit shall terminate at the end of the eighteen-month period, or at the time the holder of such temporary permit applies for a temporary educational permit issued pursuant to subsection 1 of this section. The board may issue the temporary permit provided by this subsection if:

(1) The applicant, on the effective date of this section, has had special on-the-job training and is performing the duties of a respiratory care practitioner as defined in section 1 of this act and can document such training and employment; and

(2) The board completes a background check.

4. The holder of a temporary permit as provided by this section to practice respiratory care in this state may only perform and provide such services of a respiratory care practitioner, as defined in section 1 of this act, under the direct clinical supervision of a person licensed as a respiratory care practitioner. The holder of a current and valid temporary permit, issued pursuant to this section, may not use the title or term of respiratory care practitioner or use the abbreviation of "RCP". Any holder of a temporary permit issued pursuant to this section shall show such permit upon request.

Section 11. So long as the person involved does not represent or hold himself or herself out as a respiratory care practitioner as in subdivision (12) of subsection 2 of section 1 of this act, nothing in sections 1 to 14 of this act is intended to limit, preclude or otherwise interfere with:

(1) Self-care by a patient or gratuitous care by a friend or family member;

(2) Respiratory care rendered, by any provider in the course of emergency care as defined in section 1 of this act;

(3) Performance of respiratory care procedures by other professional or licensed health care providers who have special training in the specific procedures performed;

(4) Persons in the military services or working in federal facilities from performing any activities as described in sections 1 to 14 of this act during the course of their assigned duties in the military service or a federal facility;

(5) Persons from engaging in cardiopulmonary research;

(6) Respiratory care rendered in the course of transporting a patient into or out of the state of Missouri;

(7) Individuals who, by passing an examination which includes content in one or more of the functions included in sections 1 to 14 of this act, shall not be prohibited from performing such procedures for which the individual has tested;

(8) The practice of any profession for which a license is required and issued under the laws of this state by a person duly licensed to practice that profession;

(9) The services rendered by state certified aides, assistants or technicians as defined in the long-term facility and licensure law.

Section 12. 1. The board may refuse to issue or renew, suspend or revoke, a license or permit, or place a license or permit holder on probation, or otherwise reprimand a license or permit holder, when the licensee, permit holder or applicant has been guilty of unprofessional conduct which has endangered, or is likely to endanger, the health, welfare or safety of any person, as provided in section 13 of this act or by any rule or regulation promulgated by the board.

2. If the board refuses to issue or renew a license or permit, the board shall notify the person in writing of the reasons for such refusal and shall advise the person of the person's right to file a complaint with the administrative hearing commission as provided in chapter 621, RSMo.

3. Any complaint received by the board concerning a person who is the holder of a license or permit issued pursuant to sections 1 to 14 of this act or any complaint regarding any professional practice regulated by sections 1 to 14 of this act shall be recorded as received and the date received. The board:

(1) Shall investigate all complaints concerning alleged violations of the provisions of sections 1 to 14 of this act or if there are grounds for the suspension, revocation or refusal to issue any license or permit. The board may employ investigators who shall investigate complaints and make inspections and any inquiries as, in the judgment of the board, are appropriate to enforce the provisions of sections 1 to 14 of this act;

(2) May issue subpoenas and subpoena duces tecum in order to cause any licensee, permit holder or any other person to produce records or to appear as a witness pursuant to any investigation or proceeding conducted pursuant to the provisions of sections 1 to 14 of this act;

(3) May, in lieu of or in addition to any remedy provided in this section, file a petition in the name of the state asking a court to issue a restraining order, an injunction or a writ of mandamus against any person who is, or has been, violating any of the provisions of sections 1 to 14 of this act or any lawful rule, order or subpoena of the department or the board;

(4) May, if the evidence supports such action, cause a complaint to be filed with the administrative hearing commission as provided in chapter 621, RSMo, against any holder of any license or permit issued pursuant to sections 1 to 14 of this act.

Section 13. 1. The board may discipline or sanction any holder of a license or permit issued pursuant to sections 1 to 14 of this act for any one or any combination of the following:

(1) Use of any controlled substance, as defined in chapter 195, RSMo, or alcoholic beverage to an extent that such use impairs a person's professional performance or responsibility;

(2) Has been finally adjudicated and found guilty, or entered a plea of guilty or nolo contendere, in a criminal prosecution under the laws of any state or of the United States, for any offense reasonably related to the qualifications, functions or duties of a respiratory care practitioner; for any offense for which an essential element is fraud, dishonesty or an act of violence; or for any offense involving moral turpitude, whether or not sentence is imposed;

(3) Use of fraud, deception, misrepresentation or bribery in securing any credential, license or permit, or to aid or abet any person in a violation of this subdivision;

(4) Incompetency, misconduct, fraud, misrepresentation or dishonesty in the performance of the functions or duties of a respiratory care practitioner, or a violation of any professional trust or confidence;

(5) Violation of, or assisting or enabling any person to violate, any provision of sections 1 to 14 of this act or any lawful rule or regulation promulgated thereunder;

(6) Impersonate, in any manner, or pretend to be any person holding a valid license or permit as a respiratory care practitioner, or allowing any other person to use such person's credentials;

(7) Finally adjudged incapacitated by a court of competent jurisdiction;

(8) Assisting or enabling any person to practice, or offer to practice, respiratory care services if such person does not hold a valid license or permit issued pursuant to sections 1 to 14 of this act;

(9) Use of any advertisement or solicitation which is false, misleading or deceptive to the general public or persons to whom the advertisement or solicitation is primarily directed;

(10) Being guilty of unethical conduct as defined in the ethical standards for respiratory care practitioners adopted by the division and filed with the secretary of state;

(11) Failure to notify the board of the suspension, probation or revocation of any past or currently held licenses, certificates or registrations required to practice respiratory care in this or any other jurisdiction or the failure to renew or surrender such license, certificate or registration; or

(12) Otherwise violate any provision of sections 1 to 14 of this act.

2. Violation of any provision of sections 1 to 14 of this act is a class B misdemeanor. Any fees or other compensation received by a person for any services rendered in violation of sections 1 to 14 of this act shall be refunded.

Section 14. A respiratory care practitioner may:

(1) In good faith render emergency care or assistance, without compensation, at the scene of an emergency or accident, and shall not be liable for any civil damages, for acts or omissions other than damages occasioned by gross negligence or by willful or wanton acts or omissions by such person in rendering such emergency care;

(2) In good faith render emergency care or assistance, without compensation, to any minor involved in an accident, or in competitive sports, or other emergency at the scene of an accident, without first obtaining the consent of the parent or guardian of the minor, and shall not be liable for any civil damages other than damages occasioned by gross negligence or by willful or wanton acts or omissions by such person in rendering the emergency care.