Board Should Use Clout

The jump in complaints against respiratory therapists in the past two years underscores the importance of mandatory reporting laws. Now the challenge is to see that the laws are enforced.

In 1985, California began licensing respiratory therapists, becoming one of the first states to do so.

It was a victory for consumers. Licensing the technicians who regulate respirators and ventilators and who administer aerosol inhalants and spray medications is one way to ensure that they meet at least minimal qualifications.

But an equally important safeguard was not put into place until Jan. 1, 1999, after the state Legislature passed a law mandating that hospitals, nursing homes, clinics and other employers report suspensions or terminations of respiratory therapists to the California Respiratory Care Board.

Mandatory reporting became law--and respiratory therapists, news--after Efren Saldivar confessed in 1998 to killing 40 to 50 patients at Glendale Adventist Medical Center. He recanted a few days later. But his confession set in motion a lengthy investigation, and last month he was arrested and charged with six counts of murder for allegedly injecting elderly patients with paralyzing drugs.

Glendale Adventist had received a tip that Saldivar might have assisted in patient deaths and had fired him and notified police. But the hospital never told the Respiratory Care Board.

The board revoked Saldivar’s license anyway, after receiving a tip from police, preventing him from working as a respiratory therapist elsewhere. That a mandatory reporting law is now in effect is the one positive thing to come out of this dark episode.

For nine years before the law, not a single hospital filed a complaint about a respiratory therapist. In the two years since the law mandated reporting, the board has received 57 complaints.

It has revoked the licenses of four respiratory therapists, put five on probation and warned one. Two cases were dismissed. The rest remain under investigation.

Of the therapists who lost their licenses, one falsified patients’ records, saying that developmentally disabled people under his care had received medical treatments when they had not. Another falsified time sheets and patient records, saying she had administered respiratory treatments at the same time in hospitals 30 miles apart.

These are not technicians you want entrusted to handle your medication or respirator. Yet before the mandatory reporting law, they may have been fired by one hospital only to be hired by another. The licensing board, not being told of incompetence or negligence, could not revoke their licenses.

But the law alone is not enough. Many hospitals are reluctant to report even now out of fear of legal retribution from the health care providers they report or from the patients affected. Mandatory reporting laws for doctors and other health care professionals have been on the books for decades, but state consumer protection boards are seeing an alarming decline in complaints filed.

The law empowers oversight boards to fine any hospital or licensee for failing to report incompetent or negligent employees. Boards should not hesitate to use this stick. And the Legislature should make sure that the penalty is steep enough to prod if not a hospital’s conscience than its calculator.