Professional Practice
Regulated Health Professional Act (RHPA)
The Regulated Health Professions Act identifies a number of specific activities as controlled acts; designated as such because they carry a higher degree of risk of harm associated with their performance. These controlled acts are subsequently authorized through profession specific legislation, such as the Respiratory Therapy Act.
Exception in the RHPA
There are a number of exceptions in the RHPA [s.29 (1)] that enable individuals to perform controlled acts that they do not have the legislative authority to perform. The two exceptions that are most relevant to community practice are as follows:
More information on these exceptions can be found in the CRTO’s Interpretation of Authorized Acts Professional Practice Guideline.
Controlled Acts Authorized to Respiratory Therapists
practice setting.
Other health care professionals are also permitted to perform these controlled acts; either because they are also legislatively authorized or they have had the acts delegated to them. In addition, other tasks performed by RTs are part of the public domain, and can be performed by anyone who is competent to do so. When performing a procedure, it is important to determine whether the task is a controlled act or not.
Example… The “administering a substance” portion of the 4th Authorized Act (Administering a substance by injection or inhalation) enables RRTs to apply non-invasive ventilation (i.e., CPAP, BiPAP). Simply placing a CPAP mask or other interface on a client does not fall under this controlled act.
Example… RRTs are authorized by the Prescribed Procedures regulation to perform an arterial puncture. This procedure can be performed by an RT in any employment setting (e.g., hospital, an outpatient clinic, a client’s home) provided it is permitted by their employer.
Administering a Prescribed Substance (5th Authorized Act)
The 5th authorized act (“administrating a prescribed substance”) enables RRTs to independently administer oxygen. “Prescribed” in this context
means prescribed in regulation¹⁰ and “independently” means the oxygen therapy can be provided without the requirement of an order.
This means that, in certain practice settings, RRTs can administer initiate,
titrate or discontinue oxygen based solely on their own professional judgement. However, it is important to understand that there are other pieces of legislation and policies limiting where RTs can independently administer.
The Public Hospitals Act¹¹ requires an order for every treatment or diagnostic procedure and the Independent Health Facilities Act¹² requires an order for all examinations, tests, consultations, and treatments. Therefore, RRTs are only permitted to independently administer oxygen in practice setting where these two pieces of legislation do not apply (e.g., in a client’s home).
Administering a Prescribed Substance (5th Authorized Act)
The 5th authorized act (“administrating a prescribed substance”) enables RRTs to independently administer oxygen. “Prescribed” in this context means prescribed in regulation¹⁰ and “independently” means the oxygen therapy can be provided without the requirement of an order.
This means that, in certain practice settings, RRTs can administer initiate, titrate or discontinue oxygen based solely on their own professional judgement. However, it is important to understand that there are other pieces of legislation and policies limiting where RTs can independently administer.
The Public Hospitals Act¹¹ requires an order for every treatment or diagnostic procedure and the Independent Health Facilities Act¹² requires an order for all examinations, tests, consultations, and treatments. Therefore, RRTs are only permitted to independently administer oxygen in practice setting where these two pieces of legislation do not apply (e.g., in a client’s home).
Assistive Devices Program (ADP)
The Assistive Devices Program (ADP) authorizes RRTs who meet specific criteria to complete the Application for Funding Home Oxygen in place of the prescriber. Therefore, when a physician or a nurse practitioner prescribes home oxygen therapy, an eligible RRT may complete the application – provided they are not employed (full-time, part-time or casual) for a home care company.
More information can be found of the CRTO website in the section entitled ADP Home Oxygen Application.
Local Health Integration Network (LHIN) Home and Community Care Services
Fourteen (14) Local Health Integration Networks across the province provide access to home and community care services for Ontario residents and co-ordinate admission to long-term care facilities. These LHINs coordinate access to a wide range of contracted services in the community, including Respiratory Therapy.
The Provision of Community Services Regulation (s.3.1(4) – O. Reg. 386/99), which was created under the Home Care and Community Services Act lists Respiratory Therapists as a service provider. The Respiratory Therapy Services Schedule is utilized by the LHINs to determine the range of funded services that an RT can provide in the community.
Terms, Conditions and Limitations on an RTs Certificate of
Registration
Terms, conditions and limitations (TCLs) are restrictions placed on the certificate of registration of certain classes of registration and on certain Members for specific reasons. All Graduate Respiratory Therapists (GRTs), Practical (Limited) Respiratory Therapists (PRTs), as well as some RRTs have TCLs. RTs who have TCLs on their certificate of registration are permitted to practice, provided their workplace is able to accommodate their practice restrictions.
Example…GRTs are only permitted to perform a controlled act that is authorized to the profession if it is performed under general supervision. This supervision can be provided by any regulated health care professional (e.g., RRT, RN, MD) who is authorized to perform the controlled act and is competent to do so. General supervision requires that the supervising health care professional be available to be “personally present” by the RTs side within ten minutes, if necessary.
How TCLs are Lifted
TCLs may be removed from an RT’s certificate of registration in a variety of ways. GRTs generally have their TCLs lifted after they successfully complete the Canadian Board of Respiratory Care (CBRC). Other PRTs or RRTs who have TCLs must first submit a request to, and receiving approval from, the CRTO Registration Committee.
More information can be found on the CRTO website in the section entitled Terms, Conditions and Limitations.
How this Guide Links to the Professional Misconduct Regulation
1. BUSINESS PRACTICES
19. Submitting an account or charge for services that a member knows is false or misleading.
20. Charging a fee that is excessive in relation to the service rendered.
21. Failing to disclose the fee schedule or payment structure prior to delivery of services or failing to provide the patient or patient with sufficient time to refuse the treatment and arrange for alternative services.
22. Failing to itemize an account for fees charged by the member for professional services rendered,
i. if requested to do so by the patient or patient or the person or agency who is to pay, in whole or in part, for the services, or
ii. if the account includes a commercial laboratory fee.
23. Selling any debt owed to the member for professional services; this does not include the use of credit cards to pay for professional services.
i How changing patient expectations will impact your practice. http://practicemanagement.dentalproductsrepoRT.com/aRTicle/how-changing-patient-expectations-will-impact-your-practice?page=0,1 (July, 2018)
ii CRTO Standards of Practice, Standard 1 – Business Practices
iii Ibid.
How this Guide Links to the Advertising Regulation
(1) In this Part, an advertisement with respect to a member’s practice includes an advertisement for gases used for medical purposes, equipment, supplies or services that includes a reference to the member’s name.
(2) An advertisement with respect to a member’s practice must not contain,
(a) anything that is false or misleading;
(b) anything that, because of its nature, cannot be verified;
(c) a claim of expertise in any area of practice, or with respect to any procedure or treatment, unless the advertisement discloses the basis of the expertise;
(d) an endorsement other than an endorsement by an organization that is known to have expertise relevant to the subject-matter of the endorsement;
(e) a testimonial by a patient or patient or former patient or patient or by a friend or relative of a patient or patient or former patient or patient; or
(f) anything that promotes or is likely to promote excessive or unnecessary use of services.
(3) An advertisement must be readily comprehensible to the persons to whom it is directed.
(4) A member must not permit his or her name to be used in an advertisement that contravenes subsection (2) or (3).
(5) A member must not advertise by initiating contact, or causing or allowing any person to initiate contact, with potential patients or patients or their personal representatives either in person or by telephone, in an attempt to solicit business.
(6) Despite subsection (5), a member may advertise by initiating contact with a potential patient or a personal representative of a potential patient if the potential patient does not personally use or consume the gases, equipment, supplies or services that are the subject of the advertisement.
(7) A member must not appear in, or permit the use of his or her name in, an advertisement that implies, or could reasonably be interpreted to imply, that the professional expertise of the member is relevant to the subject-matter of the advertisement if it is not relevant. O. Reg. 596/94, s. 23.
FOOTNOTES
10. General Regulation (O. Reg. 596/94 – PART VII)- Prescribed Procedures
11. Public Hospital Act, O. Reg. 965 s. 24
12. Independent Health Facilities Act, O. reg 57/92 s. 10