Licensure of the Practice of Speech-Language
Pathology and Audiology Is Needed to
Protect Public Interest

The Board Is Complying with Applicable
Laws and Rules

Issue 1: Licensure of the Practice of Speech-Language Pathology and Audiology Is Needed to Protect Public Interest.

This report is a Regulatory Board Review which requires by law a determination of whether or not the Board is necessary for the protection of public health and safety. The finding of this report is that licensing the practice of speech-language pathology and audiology is necessary for public protection. In determining if there is a need for the Board of Examiners for Speech-Language Pathology and Audiology, a primary consideration is whether the unregulated practice of the profession would clearly endanger the health and safety of the public. Table 1 identifies potential harm from improperly performed assessments and treatments.

Table 1
Harm from Improper Assessments or Treatment Procedures
Potential Harm
Audiology 1. Improper insertion of objects in the ear such as ear molds, impedence probes and probe tube microphones. 1. Damage to the ear canal and tympanic membrane. Inaccurate test results leading to misdiagnosis.
2. Incorrect usage of impedence in an ear with an open tympanic membrane and a perilymphatic fistula. 2. Meningitis, possible death.
3. Improper insertion of needle electrodes for electrophysiological testing. 3. Extension of needle into the brain causing infection and possible brain damage. Inaccurate test results leading to misdiagnosis. 
4. Assignation of hearing aid with too much gain for the recorded loss. 4. Further hearing loss. Painfully loud sounds resulting in rejection of the hearing aid and the help it can offer.
Speech-Language Pathology 1. Initiation of feeding too soon or inserting objects into the mouth for thermal stimulation during dysphagia treatment. 1. Patient choking and/or aspirating leading to aspiration pneumonia and possible death.
2. Improper placement, adjustment or monitoring of oral prostheses such as palatal lifts or obturators. 2. Tissue breakdown secondary to pressure. Or device could weaken over time, break and fall into the airway.
3. Improper insertion of speaking devices for patients on respirators. 3. Reduction in air flow.
4. Incorrect choice of augmentative devices for non-verbal patients. 4. Limitation of communication competence if choice is below the patient's abilities. Frustration, withdrawal, decreased motivation to attempt communication or rejection of subsequent devices if choice is above the patient's abilities. Inappropriate educational and vocational placement.
5. Improper usage of facilitating techniques in the treatment of voice disorders. 5. Vocal nodules.

The scope of practice for speech language pathologists and audiologists has been expanding. Since regulation was first enacted, new technologies have allowed for more specialized diagnosis and treatment, including invasive procedures. Approximately 75% of the individuals typically treated by speech-language pathologists and audiologists nationwide are under age 11 or aver age 65. Children and older persons may be more vulnerable to incompetent professionals they may encounter.

Nationwide, 47 states regulate the practice of audiology and 44 regulate speech pathology. All but three states regulate by licensure, as opposed to certification or registration. Other states have also examined the need for regulation of speech-language pathologists and audiologists. The findings are illustrated below:

It is the opinion of the Legislative Auditor that the professions of speech-language pathology and audiology require regulation to protect the public. Therefore, this Board should be continued.

Issue 2: The Board Is Complying with Applicable Laws and Rules.

The Board of Examiners for Speech-Language Pathology and Audiology has complied with applicable laws and rules. These laws and rules, primarily found within the Board's own article of Code and in the general provisions of Chapter 30, are important in the effective operation of a licensing board. The Board has complied with the following requirements:

The Board of Examiners for Speech-Language Pathology and Audiology requires continuing education. West Virginia Code §30-32-10(3) allows the Board to establish rules for continuing education and the Code of State Rules §29-1-6(c) requires those applying for license renewal to complete 10 hours of continuing education in a two year period. The Board intends to increase this requirement to 20 hours. Individuals are required to provide continuing education report forms.

The passage of House Bill 4062 during the 2000 Regular Legislative session required licensure boards to promulgate legislative rules detailing procedures for the investigation and resolution of complaints against licensees. The Board's rules (Code of State Rules §29-4) do detail these procedures. Upon receipt of the complaint, the Board informs the licensee by certified mail. The licensee must submit a written response to the Board within thirty (30) days. The Board then sends a copy of the response to the complainant. The investigator has sixty (60) days to review the complaint and report findings to the Board. Then the Board may either dismiss the complaint or suspend the license if it determines there is cause. The Board may refuse to renew a license or may suspend a license if it determines there is probable cause to believe that the speech-language pathologist's or audiologist's conduct, practices or acts constitute an immediate danger to the public. In FY 1999, the Board received one complaint which was closed after being reviewed by the Board. In FY 2000, the Board investigated a complaint alleging that an individual was practicing audiology in West Virginia without a license. The Board investigated and denied an application for licensure in the state due to a violation of rules governing the practice of audiology. A review of complaints indicate that the Board provides the fundamental components of "due process" by giving notice and the opportunity for a hearing. The complaint form provided by the Board is available in Appendix C. Table 2 indicates that West Virginia is similar to other states when the number of complaints received is measured as a percent of the total number of licensees.

Table 2
Comparison of Complaints

State #Licensees #Complaints
Kentucky 1920 2
Maryland 2161 17
Virginia 2221 5
Pennsylvania 5273  16
Ohio 4900 19
West Virginia 631 3
The number of complaints and the number of licensees are taken from Calendar or Fiscal Year 2000, depending on how different states report the information.

Financial independence and accountability are necessary for the effective operation of a licensure board. Receipts collected from licensure fees are deposited in a special revenue account, and the Board's expenses are disbursed from and charged to this account, as required by §30-1-10. Table 3 shows that the Board is self-sufficient and able to carry out its licensing responsibilities as required by law, WVC §30-1-6(c).

Table 3
Board Revenues, Expenditures and Cash Balances

FY 1998 FY 1999 FY 2000
$7680 $50,380 $10,176
$24,829 $38,497 $42,848
End of Year Cash Balance
$72,818 $84,700 $52,028
Source: 2001 PERD Analysis of Fund # 8646

The Board of Examiners for Speech-Language Pathology and Audiology has significantly improved its performance since a 1998 Preliminary Performance Review identified six areas of concern to the Legislative Auditor. The Board is accessible to the public and is in compliance with the provisions of Chapter 30 of the West Virginia Code. Through its licensure requirements, the Board assures the public that its members are competent to practice the professions and, therefore, serves to protect society's more vulnerable members from incompetent and unscrupulous providers.

Recommendation 1:
The Legislature should consider continuing the Board of Examiners for Speech-Language Pathology and Audiology.