(a) Registered Respiratory Therapists. The practice of respiratory care includes, but is not limited to, the services set forth in the law. The licensed Registered Respiratory Therapist provides these services for the assessment, treatment, management, evaluation and care of patients with deficiencies, abnormalities and diseases of the cardiopulmonary system with guidance from a qualified medical director, and pursuant to a referral from a physician who has medical responsibility for the patient.

(1) A person licensed under this Chapter as a Respiratory Therapist may evaluate and treat human ailments by respiratory therapy according to a physician’s consultation. The evaluation shall be the Therapist’s assessment of a patient’s problem and shall include a respiratory therapy diagnosis. If a patient’s problem is outside the scope of therapist, the therapist shall consult with a person licensed to practice medicine. If a patient, at any time, requires further medical evaluation or diagnostic testing, that patient shall be referred to an authorized health care practitioner.

(2) Direct referral of a patient by an authorized health care practitioner may be by telephone, letter or in person; provided, however, if the instructions are oral, the therapist may administer treatment accordingly, but must make a record describing the nature of the treatment, the date administered, the name of the person receiving the treatment and the name of the referring authorized health care

69

COL 6/21/2023

10 Guam Code Ann. HEALTH AND SAFETY
CH. 12 MEDICAL PRACTICES

practitioner.

(3) The practice of respiratory care by a licensed Registered Respiratory Therapist includes, but is not limited to, the following services:

(A) providing and monitoring therapeutic administration of medical gases, aerosolized humidification and pharmacological agents related to respiratory care procedures, but not including administration of anesthesia;

(B) carrying out therapeutic application and monitoring of mechanical ventilator support;

(C) providing cardiopulmonary resuscitation and maintenance of natural airways and insertion, and maintenance of artificial airways;

(D) assessing and monitoring signs, symptoms and general behavior relating to, respiratory care treatment or evaluation for treatment and diagnostic testing, including determination of whether the signs, symptoms, reactions, behavior or general response exhibit abnormal characteristics;

(E) obtaining physiological specimens and interpreting physiological data including:

(i) analyzing arterial and venous blood gases; (ii) assessing respiratory secretions;
(iii) measuring ventilatory volumes,
pressures, and flows;
(iv) testing pulmonary function;

(v) testing and studying the cardiopulmonary system;

(vi) diagnostic testing of breathing patterns related to sleeping disorders;

70

COL 6/21/2023

10 Guam Code Ann. HEALTH AND SAFETY
CH. 12 MEDICAL PRACTICES

(vii) assisting hemodynamic monitoring and support of the cardiopulmonary system;

(viii) assessing and making suggestions for modifications in the treatment regimen based on abnormalities, protocols or changes in patient response to respiratory care treatment;

(ix) providing cardiopulmonary rehabilitation, including respiratory care-related educational components, postural drainage, chest physiotherapy, breathing exercises, aerosolized administration of medications, and equipment use and maintenance;

(x) instructing patients and their families in techniques for the prevention, alleviation and rehabilitation of deficiencies, abnormalities and diseases of the cardiopulmonary system;

(xi) assisting with management of the cardiopulmonary system and medical equipment during off-Guam transports;

(xii) transcribing and implementing physician orders for respiratory care services;

(F) services within the training and experience of the practitioner; and

(G) services within the parameters of the laws, rules and standards of the facilities in which the respiratory care practitioner practices.

(4) Respiratory care services provided by a licensed Registered Respiratory Therapist, whether delivered in a health care facility or the patient’s residence, must not be provided, except upon referral from a physician.

(b) Licensed Certified Respiratory Therapists.

(1) A licensed Certified Respiratory Therapist is not an independent practitioner, and works under the indirect supervision of the licensed Registered Respiratory Therapist.

71

COL 6/21/2023

10 Guam Code Ann. HEALTH AND SAFETY
CH. 12 MEDICAL PRACTICES

(2) A licensed Certified Respiratory Therapist will follow the treatment program set by the licensed Registered Respiratory Therapist.

(3) The practice of respiratory care by a licensed Certified Respiratory Therapist includes, but is not limited to, the following services:

(A) providing and monitoring therapeutic administration of medical gases, aerosolized humidification, and pharmacological agents related to respiratory care procedures, but not including administration of anesthesia;

(B) carrying out therapeutic application and monitoring of mechanical ventilator support;

(C) providing cardiopulmonary resuscitation and maintenance of natural airways, and insertion and maintenance of artificial airways;

(D) assessing and monitoring signs, symptoms and general behavior relating to, respiratory care treatment or evaluation for treatment and diagnostic testing, including determination of whether the signs, symptoms, reactions, behavior or general response exhibit abnormal characteristics;

(E) obtaining physiological specimens and interpreting physiological data including:

(i) analyzing arterial and venous blood gases; (ii) assessing respiratory secretions;
(iii) measuring ventilatory volumes, pressures, and flows;

(iv) testing pulmonary function;

(v) assessing and making suggestions for modifications in the treatment regimen based on abnormalities, protocols or changes in patient response to respiratory care treatment;

(vi) providing cardiopulmonary rehabilitation,

72

COL 6/21/2023

10 Guam Code Ann. HEALTH AND SAFETY
CH. 12 MEDICAL PRACTICES

including respiratory care-related educational components, postural drainage, chest physiotherapy, breathing exercises, aerosolized administration of medications, and equipment use and maintenance;

(vii) instructing patients and their families in techniques for the prevention, alleviation and rehabilitation of deficiencies, abnormalities and diseases of the cardiopulmonary system; and

(viii) transcribing and implementing physician orders for respiratory care services;

(F) services within the training and experience of the practitioner; and

(G) services within the parameters of the laws, rules and standards of the facilities in which the respiratory care practitioner practices.

(4) Respiratory care services provided by a licensed Registered Respiratory Therapist, whether delivered in a health care facility or the patient’s residence, must not be provided, except upon referral from a physician.

SOURCE: Added by P.L. 24-329:13 (Aug. 14, 1998), amended by P.L.
25-190:4 (Jan. 22, 2001).

2015 NOTE: Subsection designations in subsections (a)(3) and (b)(3) were altered from lowercase letters to uppercase letters to adhere to the Compiler’s alpha-numeric scheme pursuant to 1 Guam Code Ann. § 1606.

§ 122005. Supportive Personnel; Delineation of
Responsibilities.

(a) A licensed Registered Respiratory Therapist is professionally and legally responsible for patient care given by supportive personnel under the Registered Respiratory Therapist’s supervision. If a licensed Registered Respiratory Therapist fails to adequately supervise patient care given by supportive personnel, the Board may take disciplinary action against the licensee.

(b) Supervision of supportive personnel requires that the licensed Registered Respiratory Therapist perform or supervise

73

COL 6/21/2023

10 Guam Code Ann. HEALTH AND SAFETY
CH. 12 MEDICAL PRACTICES

the following activities:

(1) provide initial evaluation of the patient;

(2) develop a treatment plan and program, including treatment goals;

(3) assess the competence of supportive personnel to perform assigned tasks;

(4) select and delegate appropriate portions of the treatment plan and program;

(5) direct and supervise supportive personnel in delegated functions;

(6) reevaluate the patient and adjust the treatment plan as acceptable respiratory therapy practice requires, consistent with the delegated health care task;

(7) document sufficient in-service training and periodic evaluation of performance to assure safe performance of the tasks assigned to supportive personnel; and

(8) provide discharge planning.

SOURCE: Added by P.L. 24-329:13 (Aug. 14, 1998), amended by P.L.
25-190:5 (Jan. 22, 2001).

2017 NOTE: Subsection/subitem designations added/altered pursuant to the authority of 1 Guam Code Ann. § 1606.

———-

ARTICLE 21
DIETITIAN AND NUTRITIONIST

NOTE: Article 21 was added by P.L. 24-329:14 (Aug. 14, 1998),
entitled, “”Nutritionist/Clinical Dietitian””; repealed and added by P.L.
25-192:3 (Jan. 25, 2001), entitled “”Dietitian and Nutritionist.””