≥ 92% of participants will know the current rules and laws for respiratory therapists in Florida.
CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.
≥ 92% of participants will know the current rules and laws for respiratory therapists in Florida.
After completing this course, the learner will be able to:
Respiratory therapy is one of the more recent additions to the allied health fields. The first recorded respiratory therapy program was initiated in 1943 by Edwin Levine at the Michael Reese Hospital in Chicago. A far cry from today’s highly regulated respiratory programs, devices, and professionals, Levine’s team paved the way for establishing the discipline. As the 20th and 21st centuries have rolled on, training has become more specialized and regulated, devices have become smaller, more specific, and more capable of delivering required respiratory treatments, and professionals are more highly skilled and competent (AARC, n.d.a).
The regulatory bodies have evolved with the profession. In the 1950s, standards for educational programs were outlined. Two years later, the American Medical Association authorized the creation of respiratory therapy programs based on those criteria. In 1960, the first exam was instituted to formally credential respiratory therapists (RTs). Several years later, the Board of Schools of Inhalation Therapy Technicians was formed, and shortly after, a technician certification examination was established for those who were ineligible to take the registration exam. In 1974, the two credentialing programs were combined into a single National Board of Respiratory Therapy. Twelve years later, the American Association for Respiratory Care (AARC) was renamed from the previously existing American Association for Respiratory Therapy. The same year, the National Board of Respiratory Therapy was renamed to the National Board for Respiratory Care (NRBC) (AARC, n.d.a).
The first clinical practice guidelines in respiratory therapy were developed in 1990. Sixteen years later, in 2006, the AARC established a benchmarking program to support evidence-based care in respiratory therapy. In 2009, the AARC initiated the asthma self-management education certification program, and several years later (2013), the adult critical care course was established to train therapists who wanted to receive the newly created adult critical care specialist credential. Finally, in 2016, a goal was instituted that 80% of licensed respiratory professionals should have completed at least a bachelor’s degree by 2020, and all new programs must offer a minimum of a bachelor’s degree. In 2017, the AARC celebrated 70 years since its creation (AARC, n.d.a).
The Respiratory Practice Act in Florida, most recently updated in March of 2023, is a comprehensive guidebook for legal and practice expectations of certified, registered, and/or licensed therapists.
The Laws and Rules grant the authority to regulate respiratory care applicants and licensure, provide broad statements of duties, and specify how board members are appointed. A respiratory therapist’s practice is directly affected by the ability to make informed decisions within the parameters of laws and rules. Rules need to be well-known, understood, and applied consistently in practice.
While the numerical layout of the statutes, rules, and regulations may seem complicated, it is not important to know the specific number of the statute or rule. The document is easily searchable online and has clear section headings. The rules are listed under codes beginning with 468, and the Florida statutes are listed under Title XXXII and Chapter 456. The statutes in chapter 456 cover all healthcare providers in Florida (Florida BORC, 2023; Hardt, 2020).
Check the website regularly to keep up with any changes or additions that will affect your practice. Also, ensure your contact information is up-to-date; otherwise, the license renewal notice will go to the wrong address.
According to the landing page for the BORC, they were formed to ensure that RTs in Florida are licensed and meet the minimum standards for safe practice. Licensure is a requirement to protect the people of Florida and ensure safe respiratory care. You cannot call yourself an RT or practice in the state of Florida without a license (Florida BORC, n.d.a). The BORC also disciplines and rehabilitates respiratory practitioners in Florida if warranted (Florida BORC, n.d.a).
A third purpose of the rules and laws legislation is to regulate the collection and analysis of blood gas laboratories. Those collecting and analyzing the results, leading to potential changes in the patient care plan, must be appropriately supervised by a physician (Florida BORC, 2023).
As defined in the Laws and Rules document, the following definitions apply: (Florida BORC, 2023)
The BORC is in charge of establishing the minimum parameters for professionals certified, registered, and/or licensed to deliver respiratory care services. The BORC also has the power to take disciplinary action. In disciplinary cases, the BORC can call witnesses and take testimony. Finally, the Board oversees the review of academic programs accredited for training RTs (Florida BORC, 2023, p.3).
Each respiratory care professional on the Board must have been actively engaged in delivering respiratory care services in Florida for at least four consecutive years before appointment. The term is limited to four years, and there is a two-term (consecutive) limit. To prevent too many vacancies at one time, the terms will be staggered over two, three, and four-year terms. The BORC will meet at least twice a year and can schedule additional meetings as needed. Ethical guidelines for the profession are at the discretion of the BORC (Florida BORC, 2023, pp. 3-4).
As with other healthcare fields, clinical practice requires a license. There are different parameters to obtain an initial license, maintain a current license, or reinstate a lapsed or expired license.
Therapists licensed or credentialed in another state or country may petition the BORC to consider their licensure and other criteria to be acceptable per Florida’s standards and thereby obtain their Florida license by endorsement (Florida BORC, 2023, p. 4).
Reactivating a lapsed or retired license requires additional steps. Specific instructions and licensure requirements are available here(Florida BORC, n.d.a).
For those who have not practiced in the preceding two years, a BORC-approved comprehensive review course must be completed before applying for a license or recredentialing. This step ensures that the practitioner is capable of performing the necessary skills to care for patients safely. This BORC-approved comprehensive course must include the following:
According to the Florida BORC website, the following list summarizes the complete process for obtaining a license to practice as an RT in Florida (Florida BORC, n.d.a).
Continuing education is required as a condition for the renewal of licensure of all licensed RTs.
If initial licensing occurs in the second half of the biennium, the licensee is exempt from the 24-hour continuing education credit requirement. However, they are required to take the following courses, totaling seven credits:
Licensees who currently hold a CRT and who are transitioning to an RRT credential are not exempt from the continuing education requirement at license renewal (Florida BORC, 2023, p.32).
For subsequent license renewals, the following CE requirements must be met (Florida BORC, n.d.b):
REQUIRED SUBJECT AREA | REQUIRED NUMBER OF HOURS | IMPORTANT INFORMATION |
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General Hours | 20 | |
Medical Error | 2 | Mandatory: 2 hours in a board-approved continuing education course pursuant to Rule 64B32-6.006, FAC. |
Laws and Rules | 2 | Mandatory: 2 credit hours pursuant to subsection 64B32-6.001(5), FAC Licensees may earn up to 8 continuing education hours per biennium by attending meetings of the BORC, but no more than 2 of those hours will be credited to satisfy the Florida laws and rules requirement. |
Each licensee must submit satisfactory proof to the Board of participation in appropriate continuing education using the electronic reporting system CE Broker. Education providers approved by the BORC are required to report contact hours to CE Broker. For example, CEUFast.com is a BORC provider and reports your contact hours automatically. The participant must enter continuing education contact hours by non-BORC providers into CE Broker at www.CEBroker.com(Florida BORC, 2023, p.32-33).
The Laws and Rules documentation provides many fee structures. There are licensing fees and fees for disciplinary action. Licensing fees can range between $50 (application) and $200 (license renewal). Disciplinary fees vary based on the infraction. Fines vary between $250 and $1,500,000 (Florida BORC, 2023, pp. 14-29).
Numerous behaviors can lead to disciplinary action. Ranging from bribery to practicing without a license, the severity of the punishment is based on the infraction. After committing a behavior resulting in disciplinary action, licensure could be revoked or denied, fines incurred, and further disciplinary measures taken.
The following acts constitute grounds for denial of a license or disciplinary action as specified in section 456.072(2) (Florida BORC, 2023, pp. 5-6; 13-31):
The RT has a responsibility to report breaches in practice (Florida BORC, 2023, p. 17). The Department of Health investigates complaints and reports involving healthcare practitioners and enforces appropriate Florida Statutes (Florida Health, 2023). The action that may be taken against health care practitioners is administrative. That website is here.
Disciplinary guidelines in section 64B32-5.001 are imposed by the Board when a licensee is in violation of chapter 468 or 456 or has committed an act of unprofessional conduct. The penalties correspond to the severity and repetition of the violations. Mitigating or aggravating circumstances used to justify any deviation from the specified guidelines must be called out in the final order (Florida BORC, 2023, pp. 13-29).
In determining the appropriate disciplinary action to be imposed in each case, the Board shall take into consideration the following factors (Florida BORC, 2023, p.13):
The verbal identification of offenses is descriptive only; the full language of each cited statutory provision must be consulted to determine the aberrant conduct. For applicants, any offenses listed herein are sufficient for refusal to certify an application for licensure. In addition to the penalty imposed, the Board shall recover the investigation costs and prosecution of the case. Additionally, if the Board makes a finding of pecuniary benefit or self-gain related to the violation, it shall require a refund of fees billed and collected from the patient or a third party on behalf of the patient. If the violation is not made in error but intentionally through fraud, fines are increased to $10,000 per offense or count (Florida BORC, 2023, p.13).
VIOLATION | RECOMMENDED RANGE OF PENALTY | |
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(a) Attempting to obtain a license by bribery, fraud, or through an error of the Department or the Board. (Sections 468.365(1)(a), 456.072(1)(h), F.S.) | First Offense | Minimum: Reprimand and $250.00 fine Maximum: Reprimand, $500.00 fine, and one year probation with conditions, or denial |
Second Offense | Minimum: Reprimand, $500.00 fine, and one year suspension followed by one year probation with conditions Maximum: Reprimand, $1,000.00 fine, one year suspension followed by two years probation, or denial | |
Third Offense | Revocation or denial | |
Telehealth Registrants | Revocation or denial | |
*However, if the violation is not through an error but is for fraud or making a false or fraudulent representation, the fine is increased to $10,000 per count or offense. Conditional probation and a reprimand will also be imposed for the first and subsequent offenses. | ||
If the error in licensing is due to an error on the part of the Board then a letter of concern is issued. However, licensure could still be revoked or denied. | ||
(b) Actions taken against the license by another jurisdiction. (Sections 468.365(1)(b), 456.072(l)(f), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(c) Guilt of crime directly relating to practice or ability to practice. (Sections 468.365(1)(c), 456.072(1)(c), F.S.) | First Offense |
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Second Offense |
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Telehealth Registrants |
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(d) Willfully failing to file a report as required. (Sections 468.365(1)(d), 456.072(1)(l), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(e) False, deceptive, or misleading advertising. (Section 468.365(1)(e), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(f) Unprofessional conduct. (Section 468.365(1)(f), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(g) Controlled substances. (Section 468.365(1)(g), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(h) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(i) Violation of order of the Board or Department or failure to comply with subpoena. (Sections 468.365(1)(i), 456.072(1)(q), F.S.) | First Offense |
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Second Offense |
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Telehealth Registrants |
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(j) Unlicensed practice. (Section 468.365(1)(j), F.S.) | First Offense |
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Second Offense |
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Telehealth Registrants |
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(k) Aiding unlicensed practice. (Sections 468.365(1)(k), 456.072(1)(j), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(l) Failure to perform legal obligation. (Sections 468.365(1)(l), 456.072(1)(k), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(m) Practicing beyond competence level. (Sections 468.365(1)(m), 456.072(1)(o), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(n) Delegation of professional responsibilities to unqualified persons. (Sections 468.365(1)(n), 456.072(1)(p), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(o) Malpractice. (Section 468.365(1)(o), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(p) Kickbacks or split fee arrangements. (Section 468.365(1)(p), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(q) Exercising influence or engage patient in sex. (Sections 468.365(1)(q), 456.072(1)(v), F.S.) | First Offense |
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Second Offense |
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Telehealth Registrants |
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(r) Deceptive, untrue, or fraudulent representations in the practice of respiratory care. (Sections 468.365(1)(r), 456.072(1)(a), (m), F.S.) | First Offense |
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Second Offense |
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Telehealth Registrants |
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(s) Improper solicitation of patients. (Section 468.365(1)(s), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(t) Failure to keep written medical records. (Section 468.365(1)(t), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(u) Exercising influence on patient for financial gain. (Sections 468.365(1)(u), 456.072(1)(n), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(v) Performing professional services not authorized by a physician. (Section 468.365(1)(v), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(w) Inability to practice respiratory care with skill and safety. (Sections 468.365(1)(w), 456.072(1)(z), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(x) Violation of this chapter, Chapter 456, F.S., or any rules adopted pursuant thereto. (Sections 468.365(1)(x), 456.072(1)(b), (dd), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(y) Improper interference with investigation, inspection or discipline. (Section 456.072(1)(r), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(z) Failure to report conviction or plea. (Section 456.072(1)(x), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(aa) Wrong patient, wrong site, or wrong or unauthorized procedure. (Section 456.072(1)(bb), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(bb) Leaving a foreign body in a patient. (Section 456.072(1)(bb), (cc), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(cc) Testing positive in a pre-employer ordered drug screen. (Section 456.072(1)(aa), F.S.) | First Offense |
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Second Offense |
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Telehealth Registrants |
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(dd) Being terminated from an impaired practitioner treatment program for failure to comply with the terms of contract or for not successfully completing any drug treatment or alcohol treatment program. (Section 456.072(1) (hh), F.S.) | Any Offense |
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Telehealth Registrants |
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(ee) Practicing with a delinquent, retired, or inactive status license. (Section 456.072(1)(o), F.S.) | Any Offense |
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Telehealth Registrants |
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(ff) Failure to notify a patient through written or oral notice of the type of license the practitioner holds. (Section 456.072(1)(t), F.S.) | First Offense |
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Second Offense |
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Telehealth Registrants |
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(gg) Any felony offense classified under Chapter 409, 817, 893, F.S., or 21 U.S.C ss. 801-970, or 42 U.S.C. ss. 1395-1396. (Section 456.0635, F.S.) | Any Offense |
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Telehealth Registrants |
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(hh) Terminated for cause from the Florida Medicaid program pursuant to Section 409.913, F.S. (Section 456.0635, F.S.) | Any Offense |
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Telehealth Registrants |
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(ii) Terminated for cause, pursuant to the appeals procedures established by the state or Federal Government, from any other state Medicaid program. (Section 456.0635, F.S.) | Any Offense |
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Telehealth Registrants |
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(jj) Willfully failing to comply with Section 627.64194 or 641.513, F.S., with such frequency as to indicate a general business practice. (Section 456.072(1)(oo), F.S.) | First Offense |
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Second Offense |
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Third Offense |
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Telehealth Registrants |
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(kk) Providing information, including written documentation, indicating that a person’s need for an emotional support animal under Section 760.27, F.S., without personal knowledge of the person’s disability or disability-related need for the specific emotional support animal. (Section 456.072(1)(pp), F.S. | First Offense |
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Second Offense |
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Telehealth Registrants |
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(ll) Failure to comply with the parental consent requirements of Section 1014.06, F.S. (Section 456.072(1)(rr), F.S.) | First Offense |
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Second Offense |
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Telehealth Registrants |
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(mm) Being convicted or found guilty of, entering a plea of guilty or nolo contendere to, or committing or attempting, soliciting, or conspiring to commit an act that would constitute a violation of any of the offenses listed in Section 456.074(5), F.S. | First Offense |
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Telehealth Registrants |
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(nn) Failure to display hyperlink on telehealth registrant’s website →Telehealth Registrants ONLY | First Offense |
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Second and subsequent offense |
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(oo) Failing to notify the board of restrictions placed on his or her license to practice, or any disciplinary action taken or pending against him or her, in any state or jurisdiction within 5 business days after the restriction is placed or disciplinary action is initiated or taken (Section 456.47(4)(d), F.S.) →Telehealth Registrants ONLY | First Offense |
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Second and subsequent offense |
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(pp) Opening an office in Florida or providing in-person healthcare services to patients in Florida (Section 456.74(4)(f), F.S.) →Telehealth Registrants ONLY | First Offense |
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The Board is not limited in its ability to recommend that the Department of Health pursue civil or criminal charges, if warranted (Florida BORC, 2023, p. 29).
Pursuant to section 456.077, the following violations may be disposed of by citation with the specified penalty. These violations are not a substantial risk to public health, safety, or welfare, or have been mitigated before the citation could be issued.
All citations require the practitioner to correct the violation within a specified time period (not to exceed 90 days) and submit documentation that the behavior has been corrected. If the violation is not corrected or is disputed, the licensee will be subject to section 456.073 (disciplinary action). The licensee will be required to pay any fines and investigative costs (Florida BORC, 2023, p.31).
In the case of two violations, one of which is not eligible for a citation, the procedures of section 456.073 apply. Fines must be paid within 90 days of issuance. Payment should be made to the Department of Health in Tallahassee. A copy of the citation must accompany the payment. Periodically, the Department of Health will submit a review to the Board for a licensee to include the number and nature of citations, the penalties imposed, and the licensee’s level of compliance (Florida BORC, 2023, p.31).
A notice of noncompliance will be sent as a first response to a minor rule violation. Failure of the licensee to correct the violation within 15 days will result in a citation, if appropriate, or disciplinary proceedings. Two minor violations can result in a notice of noncompliance. These include failure to notify the Board of an address change within 60 days or the non-intentional issuance of a bad check to the Department (Florida BORC, 2023, p.31).
The following violations are citation eligible (Florida BORC, 2023, p.31):
The Laws and Rules set forth by the BORC should not be used to restrict the practice of the following (Florida BORC, 2023, p.8):
Hospitals, institutions, or other employers are not required to reimburse respiratory care providers in any way to remain compliant with the Laws and Rules (Florida BORC, 2023, p.9).
Working as a respiratory therapist requires adherence to a code of ethics. According to the AARC (2021), the RCP or RT shall:
Case Study: Unlicensed Respiratory Therapy Practice in the NICU
Paul, a certified respiratory therapist (RT), is working independently in the neonatal intensive care unit (NICU) while his preceptor is off the floor due to a personal issue. Although Paul has not yet obtained his license, the nursing and physician staff believe him to be appropriately licensed and capable of independent practice.
A premature infant, born at 24 weeks of gestation, is admitted to the NICU. She was delivered 12 hours ago, with poor Apgar scores and no spontaneous respiratory effort. Immediately after birth, the infant was intubated and placed on a traditional ventilator. Her condition remained stable until about 20 minutes ago, when the nurse noticed her oxygen saturation levels in the high 70s, a rapid respiratory rate, and signs of distress. The nurse performed suctioning, auscultated breath sounds, and verified the position of the endotracheal tube (ET tube) before calling Paul for assistance.
Paul confirmed the nurse's assessment, checked the ventilator settings, and ensured the equipment was functioning properly. He reviewed the infant's medication records and saw that surfactant had been administered immediately after delivery. The nurse then called for the physician's assistance, and the infant was repositioned to optimize her airway.
Upon arrival, the physician ordered a stat chest x-ray and a second dose of surfactant. The X-ray revealed a large pneumothorax, and the physician proceeded with a needle thoracentesis to relieve the pressure. He also adjusted the infant’s ventilator settings and administered another dose of surfactant.
Meanwhile, Paul prepared an oscillating ventilator as per the physician's orders. He and the infant's nurse transitioned the infant to the new ventilator and repositioned her in the incubator. The infant showed signs of improvement shortly after the changes were made.
Upon the preceptor's return to the unit, Paul briefed him on the care provided to the premature infant, including the interventions he had carried out. The preceptor was immediately upset, as Paul had performed these critical tasks without being licensed, and without any formal communication that Paul was not yet licensed to practice independently. This lack of transparency led to a stern discussion about Paul’s actions, which were deemed inappropriate given his unlicensed status.
Several months later, the hospital faced a lawsuit alleging that the infant did not receive appropriate, licensed respiratory care. Paul and his preceptor were both charged under the Florida Respiratory Practice Act for the following violations:
The preceptor was not charged for failing to report Paul’s unlicensed status because, at the time, Paul was not licensed. Furthermore, litigation was pending against some of the nursing and physician staff for allowing Paul to provide care independently without being informed of his unlicensed status.
CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.