Respiratory therapists are healthcare providers who focus on cardiopulmonary diseases or disorders. They care for patients in hospital, physician office, and home settings, spanning age ranges from newborns through geriatrics.
Under Texas law, the Texas Medical Board holds the authority for issuing respiratory therapy permits and regulating the practice of respiratory therapists.
The scope of respiratory care is broad. Rule 186.2 defines it as, “The treatment, management, control, diagnostic evaluation, and care of inpatients or outpatients who have deficiencies and abnormalities associated with the cardiorespiratory system . . . .”
For hospitalized patients, respiratory therapists are routinely involved with patients who are intubated. Intubation refers to the process of securing the patient’s airway with an endotracheal tube. Patients are frequently intubated before a surgical procedure. When the endotracheal tube is connected to a ventilator, the ventilator measures respiratory parameters and controls breathing ventilation for the patient.
Pulmonary and respiratory medicine are complex. For intubated patients, respiratory therapists have an important role in measuring and documenting in the patient’s medical record ventilatory volumes, pressures, and flows. They also have a role in assessing a patient’s hemodynamic and respiratory status and documenting it in the medical record.
Many hospitals use electronic medical record systems that do not automatically record ventilator data and settings in patient medical records. When respiratory therapists fail to transfer this information to the patient’s medical record, along with adequate documentation of their assessments and findings, it deprives physicians of important information necessary to make medical judgments about a patient’s respiratory status.
This information is essential when it’s time to decide when it’s appropriate to extubate, or remove the breathing tube from a patient, to restore spontaneous ventilation or normal breathing. Most airway experts agree that the timing of extubation is critical, because removing the breathing tube is perhaps the most dangerous time of the intubation process.
If the patient is prematurely extubated and doesn’t quickly begin breathing on his or her own, emergency respiratory interventions are needed to prevent a permanent brain injury—and respiratory therapists are often the people charged with physically performing extubation.
Although Texas Administrative Code Rule 186.14 requires respiratory therapists to practice under the direction of a qualified medical director or physician, respiratory therapists also must comply with independent duties imposed by the standard of care.
The standard of care requires respiratory therapists to perform independent assessment of their patients and to advocate for appropriate medical care. In the context of extubation, this means a respiratory therapist is required to speak up and advocate against an order when his or her independent assessment suggests that the patient isn’t ready to have a breathing tube removed.
As a former hospital administrator, I know that advocacy doesn’t mean hostility. Good doctors listen to and appreciate patient advocacy by respiratory therapists, nurses, and other healthcare providers. If you’ve been seriously injured because of poor respiratory care in Texas, then contact a top-rated experienced Texas medical malpractice lawyer about your case.
