Current through Register Vol. 49, No. 9, September, 2024
SECTION 3:
Definitions.
A.
Board means the State Board of Health.
B.
Committee means the
Perfusionists Advisory Committee.
C.
Department means the
Department of Health.
D.
Extracorporeal circulation means the diversion of a patient's
blood through a heart-lung machine or a similar device that assumes the
functions of the patient's heart, lungs, kidneys, liver, or other
organs.
E.
Licensed
Perfusionist means a person licensed under Ark. Code Ann.
17-104-101 et seq., as
amended.
F.
Perfusion
means the functions necessary for the support, treatment, measurement, or
supplementation of the cardiovascular, circulatory, respiratory systems or
other organs, or a combination of those activities, and to ensure the safe
management of physiologic functions by monitoring and analyzing the parameters
of the systems under an order and supervision of a licensed physician,
including:
1. The use of extracorporeal
circulation, long-term cardiopulmonary support techniques including, but not
limited to, extracorporeal carbon-dioxide removal and extracorporeal membrane
oxygenation, and associated therapeutic and diagnostic technologies;
2. Counterpulsation, ventricular assistance,
autotransfusion, blood conservation techniques, myocardial and organ
preservation, extracorporeal life support, and isolated limb
perfusion;
3. The use of techniques
involving blood management, advanced life support, related functions;
4. The administration of pharmacological and
therapeutic agents or blood products or anesthetic agents through the
extracorporeal circuit or through an intravenous line for perfusion purposes as
ordered by a physician;
5. The
performance and use of:
a. Anticoagulation
monitoring and analysis;
b.
Physiologic monitoring and analysis;
c. Blood gas and chemistry monitoring and
analysis;
d. Hematologic monitoring
and analysis;
e.
Hypothermia;
f.
Hyperthermia;
g. Hemoconcentration
and hemodilution; and
h.
Hemodialysis.
6. The
observation of signs and symptoms related to perfusion services, the
determination of whether the signs and symptoms exhibit abnormal
characteristics, and the implementation of appropriate reporting, perfusion
protocols, or changes in or the initiation of emergency procedures.
G.
Perfusion
protocols means perfusion related policies and protocols developed or
approved by a licensed health care facility or a physician through
collaboration with administrators, licensed perfusionists, and other health
care professionals.
H.
Provisional licensed perfusionist means a person provisionally
licensed under Ark. Code Ann.
17-104-101 et seq., as
amended.
I.
Returning
military veteran means a former member of the United States
Armed Forces who was discharged from active duty under
circumstances other than dishonorable.
SECTION 4:
Licensure.
A. Requirements.
1. Any person is eligible to make application
to the board and receive a license, subject to the provisions of Ark. Code Ann.
17-104-101 et seq. as
amended
2. A licensed perfusionist
shall conform to the Code of Ethics as adopted by the Perfusionists Advisory
Committee and approved by the State Board of Health. See Section 5.
3. A licensed perfusionist shall at all times
hold the well-being of the patient to be paramount and shall not act in such a
way as to bring the member's interested into conflict with the patient's
interests. A licensed perfusionist shall deliver health care services without
regard to race, color, creed, national origin, sex, age, religion, sexual
preference or physical and/or mental condition.
4. The applicant shall make application upon
a form prepared by the Department.
5. A perfusionist shall practice perfusion
only when duly licensed to do so pursuant to the provisions of the Perfusion
Licensure Act, Ark. Code Ann.
17-104-101 et seq., as
amended.
6. A licensed perfusionist
shall notify the Department and the Committee of the suspension, probation,
revocation or any final disciplinary action of any past or currently held
permits, licenses, or certificates required to practice perfusion in this or
any jurisdiction of the US, US territories, District of Columbia or the
province of Canada within 30 days of final adjudication.
7. A licensed perfusionist shall report to
the Department and the Committee any alleged violation of status, rules and
regulations governing the practice of perfusion in the state of Arkansas within
30 days of the alleged violation.
8. A licensed perfusionist shall not procure
or attempt to procure a license or renewal of a license to practice perfusion
by fraud or deceit.
9. A licensed
perfusionist shall not practice perfusion after a license has expired or has
been suspended, revoked or not renewed.
10. A licensed perfusionist shall not
practice perfusion under cover of any permit, license or certificate illegally
or fraudulently obtained or issued.
11. A licensed perfusionist shall not obtain
or attempt to obtain any fee, charge, tuition of other compensation by fraud,
deception or misrepresentation or willfully over charge or over treat
patients.
12. A licensed
perfusionist shall not willfully perform inappropriate or unnecessary
treatment, diagnostic tests or perfusion services.
13. A licensed perfusionist shall not
delegate professional responsibilities to a person who is not qualified by
training, skill, competency, age, experience or licensure to perform such
responsibilities.
14. A licensed
perfusionist shall not violate or attempt, directly or indirectly, or assist or
enable any person to violate, any provisions, document, section, lawful rule,
or regulation or any Code of Ethics adopted pursuant to Ark. Code Ann.
17-104-101 et seq.
B. New Applicants
1. All new applicants for a perfusionist
license shall submit a signed application to the Department for consideration;
and Shall meet the requirements of the American Board of Cardiovascular
Perfusion (ABCP) for Certification and be certified by the ABCP.
C. Military
1. The following individuals are eligible for
licensing consideration based on military service or affiliation:
a. An active duty military service member
stationed in the State of Arkansas;
b. A returning military veteran applying for
licensure within one (1) year of his or discharge from active duty;
or
c. The spouse of (a) or (b)
above.
2. Such applicant
shall submit:
a. Payment of the initial
licensure fee;
b. Evidence that the
individual holds ABCP certification; and
c. Evidence of the military service,
qualification or affiliation.
D. Renewal. Each renewal period the licensee
must be able to provide proof of:
1. current
certification by the American Board of Cardiovascular Perfusion (ABCP) or its
successor; or
2.
(a). thirty (30) hours of perfusion-related
continuing professional education which may include ACLS, PALS, and BLS, of
which at least ten (10) hours shall be meetings, programs or activities
accredited for continuing education hours by ABCP or its successor;
and
(b). forty (40) clinical
activities annually.
I. Clinical activities
are defined as:
aa. Bypass, Primary
bb. Instructor
cc. Veno-Venous Bypass
dd. Pump Assisted Coronary and /or Organ
Perfusion (PADCAB/isolated limb perfusion)
ee. CPS
ff. ECMO
gg. VAD
hh. Documented intraoperative pump
standby
ii. Bypass first
assistant.
II. Of the 40
clinical activities above, a maximum of 15 activities may be documented
intraoperative pump standbys and/or bypass first assistant. The standbys must
be documentable in an audit. For each ECMO or VAD case, one case credit will be
awarded for initiating and maintaining on shift (4 hours minimum), or managing
one shift (8 hours minimum), or the duration of the case. Cases performed as
the Clinical Instructor in an accredited program are considered primary
perfusions and may be included in this category.
2. Regular licenses are renewable every two
years. Provisional licenses are renewable for 12 months.
3. The period of completion of the continuing
professional education and clinical activities requirements shall be the 24
(twenty-four) month period beginning January 1 and ending December 31 of each
renewal period. A licensee who has failed to obtain and report, in a timely
fashion their continuing professional education and clinical activities shall
not engage in the practice of perfusion unless an extension is obtained
pursuant to number six (6) below of this rule.
4. Each licensee shall certify by signature,
under penalty of perjury, that he/she has completed the required units of
continuing professional education and clinical activities on the renewal
form.
5. Each licensee shall retain
records documenting completion of the continuing professional education and
clinical activities requirements for a minimum of three years after the
reporting period in which the continuing professional education and clinical
activities was completed. The Board may conduct an audit of licensees to verify
compliance with the continuing professional education and clinical activities
requirements. Licensees shall assist the board in its audit by providing timely
and complete responses to the board's inquiries.
6. A licensee who cannot complete the
continuing professional education and clinical activities requirements because
of personal illness, military service or other circumstances beyond the
licensee's control which the board deems to be sufficient to impose an
insurmountable hardship may apply for an extension of time to complete the
continuing professional education and clinical activities requirements. Any
extension of time to complete the continuing professional education and
clinical activities requirements will be granted solely at the discretion of
the board. The licensee must make a written application for extension of time
prior to the January 31 deadline or completion of the continuing professional
education and clinical activities requirement. A processing fee of $50.00 shall
accompany the application for extension. The licensee shall provide full and
complete written documentation of the grounds supporting the reasons for which
an extension is sought. A licensee who requests an extension of time to
complete the continuing professional education and clinical activities
requirements shall not engage in the active practice of perfusion unless the
board grants the licensee's request for extension and the licensee received
express written authorization to engage in the active practice of perfusion.
a. The board, solely in its discretion, may
grant an extension based on unforeseeable circumstances beyond the licensee's
control which impose an insurmountable hardship precluding the licensee from
obtaining the required continuing professional education and clinical
activities. At a minimum, the licensee must provide written documentation
explaining specifically and in detail the nature of the circumstances were
unforeseeable and beyond the licensee's control, the period during which the
circumstances were in existence, the number of continuing professional
education units and clinical activities earned in the reporting period and the
licensee's plan for completing the balance of the requirements. The board, in
its discretion, shall determine if the situation described in the licensee's
application constitutes unforeseeable circumstances beyond the licensee's
control which impose an unsurmountable hardship precluding the licensee from
obtaining the required continuing professional education and clinical
activities.
b. The licensee who is
granted an extension of time shall complete the balance of his/her continuing
professional education and clinical activities requirements no later than six
months after return to work immediately following the end of the reporting
period for which an extension was sought and shall provide the board with
written documentation of his/her completion of the continuing education
requirements no later than August 10 immediately following the end of the
reporting period for which an extension was sought. Failure to complete the
continuing professional education and clinical activities requirements by
January 31st or to file the documentation with the board by August 10 shall
constitute a violation of Section D.3.
7. A licensee who has failed to complete and
report in a timely fashion the required units of continuing professional
education and clinical activities and engages in the active practice of
perfusion without the express written authority of the board shall be deemed to
have engaged in the unauthorized practice of perfusion.
E. Provisional License.
1. A license as a provisional licensed
perfusionist may be issued by the board to a person who has:
a. successfully completed an accredited
perfusion education program recognized by ABCP or its successor;
b. filed an application;
c. paid an application fee; and d. submitted
such evidence of successful completion of the education and clinical activities
as required by the board.
2. A provisional licensed perfusionist shall
be under the supervision and direction of a licensed perfusionist at all times
during which the provisional licensed perfusionist performs perfusion. Rules
adopted by the board governing such supervision and direction may not require
the immediate physical presence of the supervising licensed
perfusionist.
3. A person qualified
for a provisional license under these rules is entitled to receive a license as
a provisional licensed perfusionist. A provisional licensed perfusionist shall
comply with other pertinent sections of these rules.
4. A provisional license is valid for 12
months from the date it is issued and may be renewed annually not more than two
years by the same procedure established for renewal under Section 4 of these
rules. The application for renewal shall be signed by a supervising licensed
perfusionist.
F.
Reciprocity. License shall be granted to the licensee of another state if the
applicant holds a current certification issued by the ABCP in good standing, or
its successor and pays the appropriate application fee.
1. The applicant shall not have had a license
revoked, suspend or put on probation for:
a.
An act of bad faith; or
b. A
violation of law, rule, or ethics;
2. The applicant shall be sufficiently
competent in the field of perfusion; and
3. An applicant shall submit an application,
the required fee, and required documentation. Required documentation shall
include:
a. Copy of ABCP
Certification;
b. Evidence of
current and active licensure in that state; and
c. A list of the names of all states in which
the applicant is currently licensed or has been previously licensed;
d. Letters of good standing or other
information from each state in which the applicant is currently or has ever
been licensed showing that the applicant has not had his license revoked,
suspended or probationary status as described above.
4. The applicant shall receive a temporary
license immediately upon submission of the application, the required fee, and
the required documentation.
G. Displaying of License.
1. Perfusionists shall display their license
in an appropriate and public manner; or
2. Maintain on file in the health care
facility in which the licensed perfusionists is working, an accurate copy of
the perfusionists license; and
3.
Keep the Department informed of any change of address.
H. Fees.
1.
Initial application for consideration of licensure which requires a complete
certification of stated qualifications and credentials in the application shall
be $150.00.
2. For renewal of
license occurring every two years which checks the current credentials and
clinical activities of the already licensed perfusionist shall be
$100.00.
3. Fee for a provisional
license is $150.00 annually.
4. Fee
for reciprocity is $100.00.
5. Fee
for an extension is $50.00.
I. Continuing Education and Clinical
Activities. Licensed perfusionists and provisional licensed perfusionists shall
meet the continuing education and clinical activities requirements of American
Board of Cardiovascular Perfusion or its successor.
J. Procedure on Denial, Reprimand, Probation,
Civil Penalties, Suspension, or Revocation.
1. Grounds for Discipline. The board shall
have sole authority to deny or suspend any license to practice perfusion issued
by the board or applied for in accordance with the provisions of this chapter,
or to otherwise discipline a licensee upon determination of:
a. Any violation of Ark. Code Ann.
17-104-101 et seq.; or
b. Any violation of a regulation or code of
ethics adopted by the board;
c. Any
violation of a rule or code of ethics adopted by the board; or
d. Unprofessional conduct, which includes,
but is not limited to:
1) Incompetence or
gross negligence in carrying out usual perfusion functions;
2) A conviction of practicing perfusion
without a license or a provisional license;
3) The use of advertising relating to
perfusion in a manner which violates state law;
4) Procuring a license or provisional license
by fraud, misrepresentation or mistake;
5) Making or giving any false statement or
information in connection with the application for the license or provisional
license.
6) A plea of guilty, nolo
contendere, or a finding of guilt of a felony listed under §
17-2-102 or any offense
substantially related to the qualifications, functions, or duties of a
perfusionist, in which event the record shall be conclusive evidence;
or
7) Impersonating an applicant or
acting as proxy for an applicant in any examination required under Act 888 for
the issuance of a license.
e. If a license suspension is probated, the
department may require the licensee to:
1)
Report on a regular basis to the department on matters that are the basis of
the probation.
2) Limit the
practice to the areas prescribed by the department; or
3) Continue the person's professional
education until the licensee reaches a degree of skill, in those areas that are
the basis of the probation, satisfactory to the department.
2. Proceedings.
Proceedings shall be as follows:
a.
Opportunity for licensee or applicant to have a hearing. Except as provided in
Subsection 2) below, every licensee or applicant for a license shall be
afforded notice and an opportunity to be heard before the board. The board
shall have authority to take any action the effect of which would be to:
1) Deny a license after examination for any
cause other than failure to pass an examination;
2) Withhold the renewal or reinstatement of a
license for any cause;
3) Revoke a
license;
4) Suspend a
license;
5) Probate a
license;
6) Reprimand a
license;
7) Levy civil
penalties.
b. Suspension
of license without prior notice or hearing. If the Department finds that the
continued practice by a licensee of the occupation or profession for which
he/she is licensed will create an immediate hazard to the public, the board may
suspend the license pending a hearing without prior notice of hearing.
1) When the Department contemplates taking
any action, it shall give a written notice to the licensee at the last address
of record, which contains a statement:
a)
That the Department has sufficient evidence which, if not rebutted or
explained, will justify the Department in taking the contemplated
action;
b) Indicating the general
nature of the evidence, and detailed allegations of violation the licensee is
charged with; and
c) That a hearing
will be held on a date certain, no sooner than 20 days after the mailing of the
notice to the last address of record and at the hearing the board will receive
the evidence.
2) When
the Department shall summarily suspend a license pending a hearing, it shall
give written notice of the general nature of the evidence and detailed
allegations of the violation the licensee is charged with:
a) The Department has sufficient evidence
which, if not rebutted or explained, will justify revocation of the license by
the board;
b) Indicating the
general nature of the evidence against the licensee;
c) That, based on the evidence indicated, the
Department has determined the continuation of practice of the occupation or
profession of the licensee will create an immediate hazard to the public and
has therefore suspended the license of the licensee effective as the date such
notice is served;
d) The board will
then set an immediate hearing for a full evidentiary presentation by the
licensee and the Department.
3) In any hearing before the board involving
the suspension or revocation of the license, the burden shall be on the
Department to present competent evidence to justify the action taken or
proposed by the board.
K. Civil Penalties. The board may, after
providing notice and a hearing, levy civil penalties in an amount not to exceed
$500.00 for each violation against those individuals or entities found to be in
violation of this Chapter or rules promulgated thereunder.
1. Each day of violation shall be a separate
offense.
2. These penalties shall
be in addition to other penalties which may be imposed by the board pursuant to
this Chapter.
3. Unless the penalty
assessed under this subsection is paid within 30 calendar days following the
date for an appeal from the order, the board shall have the power to file suit
in the Circuit Court of Pulaski County to obtain a judgment for the amount of
penalty not paid.
L.
Method of Serving Notice of Hearing. Any notice required may be served either
personally or by an officer authorized by law to serve process, or by
registered mail or certified mail with return receipt requested, directed to
the licensee or applicant at his or her last known address. If notice is served
personally, it shall be deemed to have been served at the time when the officer
delivers the notice to the person addressed. Where notice is served by
registered or certified mail, it shall be deemed to have been served on the
date borne by the return receipt showing delivery of the notice to the
addressee or refusal of the addressee to accept this notice. An attempt to
serve notice at the last address of record shall constitute official
notice.
M. Venue of Hearing. Board
hearings held under provisions of this rule shall be conducted at the board
office or elsewhere in Pulaski County.
N. Hearings Public. Use of Hearing Office all
hearings under this section shall be open to the public. At all such hearings
at least a quorum of the board shall be present to hear and determine the
matter.
O. Rights of Persons
Entitled to Hearing. A person entitled to be heard pursuant to this section
shall have the right to:
1. Be represented by
counsel;
2. Present all relevant
evidence by means of witnesses, books, papers and documents;
3. Examine all opposing witnesses on any
matter relevant to the issues;
4.
Have subpoenas and subpoenas duces tecum issued to compel the attendance of
witnesses and the production of relevant books, papers and documents upon
making written request therefore to the board; and
5. Have a transcript of the hearing made at
his or her own expense.
P. Powers of the board in Connection with
Hearing. In connection with any hearing held pursuant to the provisions of this
section, the Board or its hearing officer shall have power to:
1. Have counsel to develop the
case;
2. Administer oaths or
affirmations to witnesses called to testify;
3. Take testimony;
4. Examine witnesses;
5. Have a transcript of the hearing made at
the expense of the board; and
6.
Direct a continuance of any case.
Q. Rules of Evidence. In proceedings held
pursuant to this rule, the Board may admit any evidence and may give probative
effect to evidence that is of a kind commonly relied on by reasonably prudent
men in the conduct of serious affairs. The Board may in their discretion
exclude incompetent, irrelevant, immaterial and unduly repetitious
evidence.
R. Manner and Time of
Rendering Decision. After a hearing has been completed, the members of the
Board shall proceed to consider the case and as soon as practicable shall
render their decision. If the hearing was conducted by a hearing officer, the
decision shall be rendered by the Board at a meeting where quorums of the
members of the Board are present and participating in the decision. In any case
the decision must be rendered within 90 days after the hearing.
S. Service of Written Decision. Within a
reasonable time after the decision is rendered, the Board shall serve upon the
person whose license is involved a written copy of the decision, either
personally or by registered mail to the last known address. If the decision is
sent by registered mail, it shall be deemed to have been served on the date
borne on the return receipt.
T.
Procedure Where Persons Fails to Request or Appear for Hearing. If a person
duly notified fails to appear for a disciplinary hearing and no continuance has
been granted, the Board, or its hearing officer, shall hear the evidence of
such witnesses as may have appeared, and the Board shall proceed to consider
the matter and dispose of it on the basis of the evidence before it in the
manner required.
U. Contents of
Decision. The decision of the Board shall contain:
1. Findings of fact made by the
Board;
2. Conclusions of law
reached by the Board;
3. The order
of the Board based upon these findings of fact and conclusions of law;
and
4. A statement informing the
person whose license is involved of his right to request a judicial review and
the time within which such request must be made.
SECTION 5:
Code of
Ethics
PREAMBLE: The purpose of a code of ethics is to acknowledge a
profession's acceptance of the responsibility and trust conferred upon it by
society and to recognize the internal obligations inherent in that trust. The
following paragraphs delineate the standards governing the conduct of
perfusionists in their professional interactions with patients, colleagues,
other health professionals and the general public. Realizing that no code can
encompass all ethical responsibilities of the perfusionists, this enumeration
of obligations in the code of ethics is not comprehensive and does not
constitute a denial of the existence of other obligations, equally imperative,
and not specifically mentioned herein. This code of ethics shall be binding on
all perfusionists in Arkansas.
A.
CANON 1
Perfusionists must uphold the dignity and honor of the
profession, accept its disciplines and expose without hesitation illegal,
unethical and incompetent conduct.
INTERPRETIVE STATEMENTS
* Perfusionists are part of a collaborative effort to deliver
proper health care to the patient under the perfusionist care.
* The perfusionist has a personal, as well as a professional,
obligation to protect and safeguard the patients from illegal and/or unethical
actions or the incompetence of any person.
* The perfusionist must maintain personal integrity and
establish the appropriate means to fully protect his freedom of conscience for
the delivery of services to the patient.
* A perfusionist who demonstrates incompetence or illegal
conduct as it pertains to the Code of Ethics shall be exposed to the proper
authorities.
B. CANON 2
Perfusionists shall respect the patients' rights and dignity
and shall uphold the doctrine of confidentiality regarding privileged patient
information.
INTERPRETIVE STATEMENTS
* Information about the patient's clinical situation will be
kept confidential, unless otherwise required by law, in order to protect the
welfare of an individual or community. Written guidelines or protocols of an
institution or department may be instrumental in deciding the manner in which
confidential information is handled for release.
C. CANON 3
Perfusionists shall provide only those services for which they
are qualified. Perfusionists shall not misrepresent in any manner, either
directly or indirectly, their skills, training, professional credentials,
identity or services.
INTERPRETIVE STATEMENTS
* Perfusionists will accept responsibility for the exercise of
sound judgement in the delivery of services to the patient and shall be
accountable for the quality of the service provided.
* Perfusionists will provide accurate information about the
profession, and services they provide, as well as the perfusionists' own
qualifications.
* The perfusionists shall not engage in practices beyond their
competence or training.
* Perfusionists shall not delegate to a less qualified person
any activity which requires the unique skill, knowledge and judgement of a
formally educated perfusionist. Services rendered by supportive personnel will
be under the supervision of a formally educated perfusionist.
D. CANON 4
Perfusionists shall strive to improve their medical knowledge
and skills on a continuing basis.
INTERPRETIVE STATEMENTS
* Perfusionists shall support quality didactic and clinical
education.
* Professional conduct will be maintained toward perfusionists
peers, students, medical staff and patients.
* Perfusionists shall participate in educational activities,
either by individual study or through continuing education, which will enhance
their basic knowledge in order to continue to provide quality health care to
the patient.
E. CANON 5
Perfusionists shall maintain and promote high standards for
perfusion practice which may include education, research and scientific
presentations and/or publications.
F. CANON 6
A perfusionist shall at all times hold the well-being of the
patient to be paramount and shall not act in such a way as to bring the
member's interests into conflict with the patient's interests. A perfusionist
shall deliver health care services without regard to race, color, creed,
national origin, sex, age, religion, sexual preference or physical and/or
mental condition.
INTERPRETIVE STATEMENTS
* A perfusionist professional practice and adherence to ethical
principles shall take preference over business practices. Perfusionists shall
place service before material gain.
* A perfusionist shall fully disclose to clientele other
business practices that may appear as conflict of interest to clientele and/or
public. These may include but are not limited to:
1) Consultant for fee.
2) Clinical instructor (support staff for
industry).
3) Sales
representative.
4) Technical
advisor.
5) Lecture for
fee.
6) Acceptance of fees,
gratuities, funding from industry.
In that the ultimate concern is to improve patient care, it is
our position that clinicians engaged in the practice of cardiopulmonary bypass
are required to and must be allowed to periodically evaluate the equipment
which is utilized in cardiopulmonary bypass in the effort of continuously
improving patient care which should include not only patient outcomes but
safety as well.
To this end, the State Board of Health holds that each
perfusionist has the following ethical and professional
responsibilities:
A. The perfusionist
being the most qualified individual, by training, education, experience, and
job description has the responsibility to evaluate, recommend, select, and
implement the components of the extra-corporeal circuit so that patient safety
and care are optimized.
B. The
perfusionist will always attempt to fairly evaluate all competing products and
services, with the principal selection criteria being that of regard for
patient safety and well-being.
C.
The perfusionist shall always base any decision on product and service
selection on clinical evaluations and documented clinical and scientific data.
In conclusion, it is the responsibility of the perfusionist to
make decisions regarding the selection of clinical products with the patient as
the primary concern.
