Registered Polysomnographic Technologists (RPSGT’s): Recent Developments in the Law

Author: Thomas Hill, MD

Dr. Hill, of Hickory, is a member of the NC Medical Board. He currently practices at Western Piedmont Anesthesia, PA, in Conover, NC.

The 2009 North Carolina General Assembly passed into law "The Polysomnography Practice Act," (S.L. 2009-434), which regulates the practice of registered polysomnographic technologists (RPSGTs). Also known as "sleep techs," RPSGTs perform and assist in interpreting sleep studies to aid physicians in the diagnosis of sleep disorders.

The new law mandates that the North Carolina Medical Board maintain a registry of RPSGTs that are registered by the Board of Registered Polysomnographic Technologists (BRPT). The Medical Board will collect the following information: the name, full address, the date of registration with the BRPT, and proof of registration. The Medical Board is not responsible for determining whether registration of a practitioner is appropriate, and the Board will not discipline RPSGTs for substandard practice. Instead the Board merely acts as the repository for the registry information.

The new law further requires that RPSGTs work under the indirect supervision of a physician. The supervising physician is required to have policies and procedures in place for the safe and appropriate completion of RPSGT services and must be readily available to render assistance if needed. However, on-site supervision is not required. The law mandates that sleep studies may only be performed in a hospital, standalone sleep laboratory or sleep center, or in a patient’s home. The law permits other licensed or registered health care professionals or those working under the supervision of another health care professional to perform sleep studies; however, only those individuals registered with the Medical Board may call themselves "RPSGT."

After January 1, 2012, it shall be illegal for individuals who are not registered with the Medical Board to do any of the following: (1) practice polysomnography; (2) represent, orally or in writing, that the person is credentialed to practice polysomnography; or (3) use the title "Registered Polysomnographic Technologist" or the initials "RPSGT." Violation of this law shall be a Class I misdemeanor.

PSGT students and those involved in institutional review board-approved research studies will be exempt from these prohibitions.

The North Carolina General Assembly tasked the Medical Board with identifying standards for physicians supervising RPSGTs, with the goal of improving the quality and safety of sleep studies. Accordingly, the Medical Board convened a work group, which I chaired. The work group consisted of Bradley Vaughan, MD (Chapel Hill), and RPSGTs Karen Monarchy Rowe (New Bern) and William Underwood (Chapel Hill) to establish those standards. The following was adopted by the North Carolina Medical Board in January 2010.

Physician Supervision of Registered Polysomnography Technologists (RPSGTs)
In addition to the requirements set forth in the Position Statement entitled, "Physician Supervision of Other Licensed Health Care Practitioners," the following requirements apply to physicians who supervise Registered Polysomnography Technologists:

The physician shall be immediately available, either in person or by telephone or electronic means, at the time polysomnography services are rendered.

The physician shall establish a written scope of practice not to exceed that permitted by the North Carolina Polysomnography Practice Act. Protocols shall be in place for each RPSGT under the physician’s supervision. Protocols shall be written, updated and reviewed at least annually. Scope of practice documents and protocols shall be available at each testing site and shall be immediately available for inspection by an agent of the Board.

The physician shall require the RPSGT to update the RPSGT’s current and complete address and contact information, including home and all practice locations, with the supervising physician within thirty days of any changes.

The physician shall ensure that the RPSGT makes the supervising physician’s contact information available to all patients seen by the RPSGT and informs patients that they are encouraged to call the supervising physician with any concerns regarding the RPSGT’s performance.

The physician shall have current knowledge of the proper operation and calibration of equipment used by the supervised RPSGT.

It is further recommended that the supervising physician attend continuing medical education in the area of sleep medicine.

The Medical Board will develop more detailed procedures for RPSGTs who must register under the Act closer to the January 2012 implementation deadline. Please review the Board’s website at www.ncmedboard.org and upcoming issues of the Forum for further information.