Speech Pathologists and Audiologists

You asked (1) if Connecticut’s speech pathologist scope of practice law prohibits practitioners from performing swallowing and feeding therapies and if they face any liability for doing so, (2) whether new national audiologist certification requirements affect state licensing requirements, and (3) whether Connecticut uses certification by a national body as a standard for professional licensing.

Dealing with swallowing and feeding disorders appears to be an acknowledged function of speech pathologist practice, and nothing in Connecticut law appears to bar licensed pathologists from performing such work. A pathologist who provides swallowing or feeding (or any other) services is at risk for claims of malpractice. The standard for determining liability in such a case is whether he or she exercised the same degree of skill and care that another speech pathologist would ordinarily exercise in similar cases. If not, and the person making the claim is injured as a result of the pathologist’s action or inaction, he or she is liable.

Connecticut law requires an initial audiologist licensure candidate to have completed at least 36 weeks (1,080 hours) of supervised professional employment after the candidate received the requisite graduate degree. New American Speech-Language Hearing Association (ASHA) certification requirements, which take effect in 2007, require audiology students to complete 52 weeks of full-time clinical practicum experience during graduate school. Unless Connecticut law is changed, ASHA-certified audiologists who have had 52 weeks of clinical experience during grammar school would appear to be required to complete another 36 weeks in order to become licensed in Connecticut.

Most health care professionals must pass an exam in order to receive a Department of Public Health license to practice. But the public health commissioner can waive the exam requirement for some professions if the license candidate is certified by an approved national professional organization. These professions include speech pathologists and audiologists, occupational therapists, psychologists, and dietician-nutritionists.

the application of principles, methods and procedures for the measurement, testing, diagnosis, prediction, counseling or instruction related to the disorders of speech, voice, or language for the purpose of diagnosing, preventing, treating, ameliorating or modifying such disorders and conditions in individuals or groups of individuals (CGS § 20-408(1).

The American Speech-Language Hearing Association, the body that certifies speech-language pathologists and audiologists, revised its scope of practice statement in 2001. This document states that the “practice of speech-language pathology includes prevention, diagnosis, habilitation, and rehabilitation of communication, swallowing, or other aerodigestive disorders…. ” (Aerodigestion refers to aeromechanical events related to communication, breathing, and swallowing. )

The practice of speech pathology, according to this document, involves, among other functions:

1. providing prevention, screening, consultation, assessment and diagnosis, treatment, intervention, management, counseling, and follow-up services for disorders of (a) “swallowing or other upper aerodigestive functions such as infant feeding and aeromechanical events” and (b) sensory awareness related to communication, swallowing, or other upper aerodigestive functions;

2. using instruments to observe, collect data, and measure parameters of communication and swallowing, or other upper aerodigestive functions;

3. selecting, fitting, and establishing effective use of prosthetic/adaptive devices for communication, swallowing, or other upper aerodigestive functions;

4. addressing behaviors and environments (e. g. , seating, positioning for swallowing safety or attention) that affect communication and swallowing, or other upper aerodigestive functions; and

5. educating and counseling individuals, families, co-workers, educators, and others regarding acceptance, adaptation, and decision making about communication and swallowing, or other upper aerodigestive functions.

This scope of practice document states that it does not supersede or affect the interpretation or implementation of state licensure laws. And it cautions practitioners who are asked to perform services (e. g. , collaborative service delivery in schools) that “… it is both ethically and legally incumbent…to determine that they have the knowledge and skills necessary to conduct such tasks. ”

Like any other health care professional, a speech pathologist who provides swallowing or feeding services is at risk for claims of malpractice. The standard for determining liaibility in such cases is whether he or she exercised the same degree of skill and care that another speech pathologist would ordinarily exercise in similar cases. If not, and the person making the claim is injured as a result of the practitioner’s action or inaction, the pathologist is liable.

A candidate for an audiologist license must have had at least 36 weeks (1,080 hours) of full-time, or 48 weeks (1,440 hours) of part-time, professional employment under the supervision of a licensed or certified audiologist. He must have completed this experience after completing his graduate degree (a master’s or doctorate is required for licensure, CGS § 20-411).

ASHA adopted new certification standards in 1997 that take effect in two stages. A transitional stage runs between 2007 and 2011. During this stage, audiology students must complete a minimum of 75 semester credit hours of post-baccalaureate study that ends in a master’s, doctorate, or other academic degree in a program accredited by ASHA’s Council on Academic Accreditation. This phase ends December 31, 2011. After that date all audiologists must earn a doctoral decree from an accredited program. Graduate study programs during the transition period and doctoral programs after 2011 must include at least 12 months of full-time equivalent supervised clinical practicum.

ASHA’s standards specify that the total of these clinical experiences should equal 52 workweeks. ASHA says clinical practicum experiences should occur throughout the graduate program. For its purposes, a week means 35 hours in direct patient/client contact, consultation, record keeping, and administrative duties relevant to audiology service delivery.

Reading the new ASHA and existing Connecticut clinical requirements together appears to require ASHA-certified audiologists who have had 52 weeks of clinical experience during graduate school to complete another 36 weeks of supervised post-graduate clinical work in order to become licensed in Connecticut.

(The new ASHA standards also require certified audiologists to accumulate 30 hours of continuing education every three years. This standard took effect January 1, 2003. But, unlike requirements for several other health care professionals, Connecticut law does not require continuing education for audiologist license renewal. )

Connecticut requires most health care professionals to pass an exam in order to receive a license to practice from the Department of Public Health. But, for some professions, it permits the public health commissioner to waive the examination requirement if the license candidate holds a certificate from an approved national professional organization. These professions include: speech pathology and audiology (CGS § 20-411(b)(2), occupational therapist (§ 20-74c), psychologist (§ 20-190), and dietician-nutritionist (§ 20-206n).


September 30, 2004		2004-R-0767
SPEECH PATHOLOGISTS AND AUDIOLOGISTS

By: Saul Spigel, Chief Analyst