HOUSTON In Texas you need a license just to give a massage, or use a laser hair remover. But soon you might not need one to be a respiratory therapist, or X-ray technician in a hospital.

That idea has a lot of people concerned.

The pumping of a ventilator is the soundtrack of a hospital, steady as a heartbeat and just as necessary. By its side, you ll often find a respiratory therapist, monitoring the machines and the patients they keep alive.

In life and death situations, CPR, managing an airway, said Darby Cruz, Respiratory Therapy manager at TIRR Memorial Hermann Hospital.

But a new recommendation from the Texas Sunset Advisory Commission would de-regulate the profession, along with 18 others, because the system is overwhelmed. Supporters say patients would still be protected through other safeguards, but not everyone is convinced.

Everybody s response that I ve heard to it is just shock and dismay, said Dr. Matt Davis, the Spinal Cord Injury director for TIRR Memorial Hermann.

Of the 1,200 patients TIRR Memorial Herman sees every year, fully three-quarters will need some kind of respiratory care, and the 22 therapists there provide some of the most vital services a patient can receive.

You can only go for a few minutes without air, versus days without water or food, said Davis.

Joseph Carbajal knows that first-hand. Severely injured in a rollover accident, he spent eight months on a ventilator.

It felt like I was suffocating, said Carbajal.

Trained respiratory therapists helped him adjust, and then wean off the machine, so the rest of his recovery could move forward.

I wouldn t be where I am today, said Carbajal.

But advocates say without a license, there s no guarantee about how a therapist is trained.

A hospital later down the line can decide, I can just train somebody off the street, said Cruz.

No guarantee either on how they re vetted.

You wouldn t know if the person standing beside you, acting as a respiratory therapist, has had their license revoked in some other state, said Cruz.

So advocates say it s time to take a breath and think again.

It is a huge public safety issue, said Cruz.

The Texas Sunset Advisory Commission will meet June 24 and 25 in Austin to talk about the recommendations and take public comment.

No decision is expected until August, and state lawmakers still have to pass any changes into law next year.

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