Legislature(2003 - 2004)
04/27/2004 03:11 PM House HES
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HB 186-LICENSING RADIOLOGIC TECHNICIANS Number 1496 CHAIR WILSON announced that the next order of business would be HOUSE BILL NO. 186, "An Act establishing the Radiologic Technology Board of Examiners; requiring licensure of occupations relating to radiologic technology, radiation therapy, and nuclear medicine technology; and providing for an effective date." Number 1492 JIM SHINE, Staff to Representative Tom Anderson, Alaska State Legislature, presented HB 186 for Representative Anderson, sponsor of HB 186, and answered questions from the committee. He read the following statement into the record: The unregulated practice of Radiologic Technology, Nuclear Medicine Technology and Radiation Therapy by unqualified individuals represents a serious health risk to the citizens of Alaska. HB 186 will establish educational and certification standards for health care personnel in Alaska who perform medical imaging and radiation procedures. The Radiologic Health Science Professionals in Alaska are dedicated to the preservation of life and health, as well as the prevention and treatment of disease. The use of x- rays and other medical imaging disciplines is the most acceptable method for discovering and treating many conditions that might not otherwise be observed until it is too late for treatment. Any radiology procedure is only as effective as the person performing it. An underexposed chest x-ray cannot reveal pneumonia or a malignant lesion, just as an inadequate mammography technique cannot detect breast cancer. No matter what the procedure, the radiologic technologist's knowledge of anatomy, careful application of radiation and skillful operation of sophisticated medical equipment are the keys to its success. To be clinically useful diagnostic-imaging exams must be accurate. The Alaska Society of Radiologic Technologist has consistently supported the enactment of state standards for the education and credentialing of radiologic technologists, radiation therapists and nuclear medicine technologists as a means of protecting Alaskans from the harmful effects of excessive and unnecessary exposure to medical radiation. Thirty-eight states have adopted recommendations for state licensure of radiology personnel, while Alaska is not one of those 38. Establishing these standards will ensure that Alaskans will have access to safe and high quality radiologic care. Licensure will establish radiation protection measures, as well as education and credentialing standards that will ensure the competency of persons operating medical equipment emitting radiation. To ensure that the citizens of Alaska receive maximum protection from the harmful effects of excessive and improper exposure to radiation, licensure must be passed to establish standards. Number 1429 MR. SHINE commented that there are a number of people on-line that would like to testify on the bill. Number 1329 REPRESENTATIVE SEATON moved to adopt CSHB 186, 23-LS0380\E, Mischel, 4/20/04, as the working document. There being no objection, CSHB 186, version E, is before the House Health, Education and Social Services Standing Committee as the working document. Number 1258 CHRISTINE LUNG, Director, Government Relations, American Society of Radiologic Technologists (ASRT), testified in support of HB 186. She told the members that ASRT represents over 112,000 radiology technologists practicing in all states. The Alaska Society of Radiologic Technologists is an affiliated chapter of the ASRT. Ms. Lung said that ASRT supports HB 186 which would set down education and credential standards for radiographers, radiation therapists, nuclear medicine technologists, and limited radiologic technologists. Currently patients believe that everyone that they see in a physician's office or hospital is an educated and credentialed health care practitioner. However, in 11 states that is not necessarily the case. In those states anyone can be hired by a hospital or physician's office to perform critical medical imaging and radiation therapy procedures on patients without any formal education or certification of their capability to do so, she said. Number 1187 MS. LUNG pointed out that currently there are 235,000 radiologic technologists who are voluntarily registered by the American Registry of Radiological Technologists. It is hoped that technologists in Alaska will have the opportunity to present to their patients credentials that would show that they are educated to perform these procedures. The educational and credentialing standards that are in HB 186 reflect the current professional standards of graduation from an approved educational program. These programs are approved by the Joint Review Committee on the Education on Radiologic Technology and national certification by the American Registry of Radiological Technologists. Ms. Lung told the members that currently there are over 400 technologists in the state that possess these credentials. MS. LUNG explained that the credentials are important because medical imaging accounts for 90 percent of human exposure to manmade radiation. It encompasses 40 percent of acute care health care costs, she added. In summary, Ms. Lung told the committee that HB 186 would ensure a reduction in exposure to radiation, reduced health care costs, and improved radiological health care to all patients. Number 1089 ANN DAILEY, President, Alaska Academy of Physician's Assistants, testified in opposition to HB 186. She shared that she is a physician's assistant in Iliamna and previously worked in the rural community of St. Paul. Ms. Daily explained that there are no radiologic technicians available in the remote villages and for this reason oppose HB 186. In remote villages only limited radiography is performed as it is described in the bill. The provision of limited radiographic services to patients is well within physician's assistant's scope of practice which is regulated by Alaska statute and supervised by collaborative physicians. Radiologists over read our images and report any suspicions concerning quality, appropriateness, and over and under radiation levels to our supervisors. The equipment itself reads the amount of radiation a patient is exposed to, she explained. Quality checks and calibrations are done every six months by certified personnel, she added. MS. DAILEY told the members that HB 186 will impose an untenable burden to the provision of health care to our most vulnerable patients in Rural Alaska. It will also erect a barrier to care by unreasonably and unnecessarily adding an additional bureaucratic administration, licensing requirements, fees, and examination to those already imposed, she stated. In areas of Alaska where tuberculosis, emphysema, asthma, and trauma are commonplace the ability to differentiate these conditions radiographically is key to prompt diagnosis, targeted treatment, and prevention of public health emergencies and loss of life and limb. She urged the members to hold HB 186 as it is an impediment to the underserved people in Rural Alaska. Number 0869 CLYDE PEARCE, Chief, Radiological Physicist, Radiological Health, Division of Public Health, Department of Health and Social Services, testified on HB 186 and answered questions from the members. He told the members that he performs inspections at facilities throughout the state including 23 hospitals and 137 medical facilities. Mr. Pearce explained that he is supportive of the bill because it addresses some of the concerns he has with the supervision of professional health care providers because these professionals do not understand radiology. He said his greatest concern is that the exposure to radiation in general is increasing with new technologies. For example, the exposure to radiation through mammography has increased even though the exposure time has decreased. The increased speed of the exposure makes the margin for error narrower, he explained. MR. PEARCE told the members that Alaska has a unique problem where there is new technology and old equipment. For example, in Southeast the blue light used in x-rays are to be used with blue sensitive film; however, new green film was used and unfortunately green film cannot see blue light. The automatic machines cannot detect those kinds of incompatibilities, he said. As a result patients have received increased radiation exposure, rather than correcting the problem. Number 0788 CHAIR WILSON asked Mr. Pearce to clarify the point he made concerning the blue and green film. MR. PEARCE explained that it takes a lot of x-rays to get an image if the film is exposed in an open manner, so what has been used for 100 years is an intensifying screen which converts x- rays into (indisc.) light and the film is exposed to that (indisc.) light. An x-ray film is designed to be most sensitive to a particular color of light, rather than a full spectrum of light. The old screens use a blue light, and x-ray film was made to be sensitive to the blue light. The new screens emit green light, so the new film is especially sensitive to green light, which is the standard now. Mr. Pearce said he has seen two facilities using the old obsolete screen x-rays with new green sensitive film and as a result the patients were getting 6 to 10 times the amount of radiation exposure. The staff did not even know it, he added. CHAIR WILSON surmised that higher amounts of radiation exposure was due to the fact that the film didn't come out so the technician would turn up the machine and do it again. MR. PEARCE replied that is exactly right. Number 0646 REPRESENTATIVE SEATON asked Mr. Pearce to comment on digital equipment. He asked if this equipment requires a lesser dosage of radiation. MR. PEARCE replied that digital imaging is designed for safety. This process gets away from film processing. An advantage to digital imaging is that the image can be manipulated by increasing contrast or brightness. He commented that digital equipment does not guarantee lower dosages because it largely depends on who is operating the machine. In fact, he said he believes technicians can get a little lazy and add more radiation exposure to ensure that a good amount of data is obtain so that it can be manipulated, he added. Potentially, digital equipment could reduce exposures, but in practice it is often doubled or more depending on the operator. CHAIR WILSON commented that whenever a facility purchases a new digital imaging machine training is provided to the staff. Number 0541 MR. PEARCE agreed that training is provided. He compared the training of staff to a person who has a car with an automatic transmission and then buys a new car with a standard transmission. The trainer may teach the individual to use the stick shift, but will not teach the rules of the road and help the driver get a driving license. The trainer will be teaching staff the unique aspects of that digital imaging machine. It will not be a replacement for learning how to do radiography, he added. Number 0472 DONNA RUFSHOLM, Chair, Licensure Committee, and Board Member, Alaska Society of Radiology Technologists Board Member, testified in support of HB 186. She told the members that in 1991 the U.S. Congress recognized the need to regulate the operators of radiology equipment. It passed legislation saying that all states would have in place licensure programs for those individuals who perform radiology procedures, she said. Unfortunately, there were no repercussions for the states that did not comply with the law. She explained that today there is legislation that would make licensure mandatory for all states. If states do not comply the Medicare and Medicaid funding could be cut. Of the 50 states 38 have licensure laws in place, but Alaska is not one of them, she pointed out. Deficiencies in the use of radiation have been witnessed all over the state of Alaska which has prompted the Alaska Society of Radiology Technologists to write regulations for those who perform those procedures. MS. RUFSHOLM told the members that HB 186 was written to ensure quality patient care, as well as protecting those operating the radiology devices. She emphasized that it was not the intent of the Alaska Society of Radiology Technologists to deny rural residents of radiology services, but to provide training and education to staff who operate the equipment. Number 0276 ED HALL, Physician's Assistant (PA), Member, Alaska Academy of Physician Assistants, testified in opposition to HB 186. He told the members that he has been a practicing PA for ten years and a member of the academy for nine years. Mr. Hall explained that in his discussions with PAs across the state he has found that there is great concern about the ability to provide care to patients, particularly in the rural areas of the state, but also in the urban areas of Alaska as well. He acknowledged that there are providers out there using antiquated equipment; however, this bill is directed toward those using the equipment, not to the highest technology or inappropriate equipment. Mr. Hall said he would hope anyone using radiology equipment would stay current. All providers that he knows have been through extensive anatomy courses, he stated. Mr. Hall reiterated that this appears to be another self-serving bureaucratic attempt at creating another office which will reduce access to optimal care to Alaskans. In summary, he emphasized that this bill will increase the cost of health care. TAPE 04-38, SIDE A Number 0033 ERIKA WHITE, Program Director, University of Alaska Anchorage (UAA), testified in support of HB 186. She told the members that the university currently has an Associates of Applied Science Degree in Radiologic Technology. There are also students enrolled in Fairbanks, Juneau, and Ketchikan. It is a 21-month educational program that includes physiology and anatomy courses, safety training, and proper exposure and positioning training. The course curriculum has been approved by the national accrediting body. This training course prepares students to take the national exam. MS. WHITE commented that the university received $84,000 to implement a limited radiology program which will be offered in the fall to PAs and nurses. She emphasized that this is not full training, but limited training. There is a need throughout the state for trained professionals who are licensed and this program should address those needs. Ms. White said that the most successful facilities are those that provide students with funding, by contracting or sponsoring students who then come back to its facility to work. She commented that rural health facilities are not doing that and it is important for those facilities to recognize that there are ways to attract registered technologists. Number 0292 JOHN BRINGHURST, Administrator, Petersburg Hospital, testified in opposition to HB 186. Petersburg Hospital is a 27-bed hospital and long-term care facility that serves a community of 3,500 people whose only access to urgent care services comes from this facility. Mr. Bringhurst pointed out that like most Southeast communities Petersburg does not have road access to other medical facilities, so transportation is required either by the marine highway system or air transportation. MR. BRINGHURST told the members that he was selected by the Alaska State Hospital and Nursing Homes Association (ASHNA) and Providence Hospital to represent both the small and large hospitals' interests in working with proponents of HB 186 and to influence revisions in the bill so that ASHNA can support it. While there have been efforts to this end, he said he does not believe that ASHNA can support HB 186 because it has serious flaws. The bill now has provisions for limited licensing for personnel which might help small hospitals comply with the requirement. However, the drafters of the bill used the definition of limited license to apply to the size of the community the person is employed in rather than the scope of the work being done. Many health care professionals make provisions for limited scope workers; such as CNA, LPN, pharmacy technicians, and physical therapy aides, etc. However, the limitations lie in the role he/she is able to play in the delivery of the service and not on the size of the community. He summarized by saying he questions the timing of this legislation. Mr. Bringhurst said he believes this is the worst time to implement this policy since Alaska is experiencing a shortage of radiological technicians. Recently ASHNA conducted a poll which showed radiology technicians as the number two position in terms of scarcity, which is only surpassed by registered nurses. In Petersburg there is a 100 percent vacancy rate in radiology and one of those positions has been vacant for over 22 months. Small hospitals have a hard time attracting radiology technicians and often find the only solution is to train staff themselves. He said this legislation would have some short-term negative impacts that would nullify the good that is being accomplished. Mr. Bringhurst said he believes there are serious flaws that need to be addressed before this would be a good piece of legislation. Number 0559 B. J. ANDERSON, Laboratory and X-Ray Manager, Anchorage Neighborhood Health Center, testified on HB 186. She explained that the Anchorage Neighborhood Health Center is a community health center. Ms. Anderson commended UAA for creating excellent course work for radiologic technicians. She said she believes that the new on-line program will be a great benefit; however, she expressed concern with required licensing at the state level. Ms. Anderson told the members that this will create a barrier for those interested in radiologic careers and job opportunity. This kind of career opportunity is common in rural areas, small clinics, physicians' offices, and community health centers, she said. It is difficult for these small and rural offices to recruit certified personnel. She said she can't over state that fact. For instance, at Iliuliuk Family & Health Services, Inc. in Dutch Harbor there are three individuals who have been trained in radiological procedures; one was trained in the Philippines and the other two were trained on the job. She stated that these individuals have excellent skills, but none of the three are certified. These individuals are also cross-trained to perform lab testing. This is an important dynamic in rural health. She told the members that she has an employee that is highly skilled, trustworthy, dependable, and of high integrity. Things that cannot be gauged by licensing alone. While he does not have a national certificate, he is the best employee she has. Ms. Anderson told the members that state licensing created barriers for her in two other states that she has worked. Ms. Anderson summarized that she believes education is the key, not licensing. People entering the health care field will seek further education. For these reasons she opposes HB 186, Ms. Anderson stated. Number 0746 VERA JAMES, Program Manager, Alaska Native Health Board, testified in opposition to HB 186. She told the member that the Alaska Native Health Board is nonprofit organization established in 1968 that advocates for 229 federally recognized tribes on health care issues. The board believes that the adoption of HB 186 as currently written will be harmful to tribal health providers ability to provide x-ray services in the smaller communities that are unable to support radiology technicians. This is because community health aides in many remote villages are the only providers available to take images as there would be no licensed practitioner on-site. It is for these reasons the Alaska Native Health Board opposes HB 186. Number 0852 BARBARA HUFFTUCKNESS, Director, Governmental and Legislative Affairs, Teamsters Local 959, testified in support of HB 186. She explained that Teamsters Local 959 represents all the employees at South Peninsula Hospital in Homer. While the community is connected by the road system, the residents there consider themselves somewhat rural. She added that Teamsters Local 959 also represent the employees at Kodiak Island Hospital. She said that she always made the assumption that radiologic technologists performing the tests were licensed. Every employee who is hired at South Peninsula Hospital must meet high standards. Ms. Hufftuckness said that Teamsters Local 959 support HB 186 because it is believed it is a career opportunity in building growth. Employees that have worked within the system, for example certified nurses aides, are required to go through the licensure process. Many careers require licensing including nurses. It does not make sense to say that because there is a shortage of nurses that licensing on nurses should be eliminated. Ms. Hufftuckness said that she sympathizes with rural areas that have difficulties finding employees, but sees it as a career opportunity both in rural and urban areas of the state. She reiterated Teamsters Local 959's support for passage of HB 186. Number 1050 CHAIR WILSON asked Mr. Shine if there is a senate-matching bill. Number 1079 MR. SHINE replied there is not. He commented that he is not sure that some of the testifiers have the current version of the bill. The last version of the bill on Basis is one that passed out of the House Labor and Commerce Standing Committee in January. He noted, however, the bill before the House Health, Education and Social Services Standing Committee is dramatically different. One of the testifiers mentioned that this bill would create a new level of bureaucracy; however, one of the major changes is that the bill's language went from having a board with the Alaska Society of Radiologic Technologists and other members from the industry taking care of the licensing issue to the Division of Occupational Licensing handling it, he said. He emphasized that no new level of bureaucracy is being created. MR. SHINE commented that if anyone has questions about the bill Donna Rufsholm of the Alaska Society of Radiology Technologists is very knowledgeable. He emphasized that there are dramatic changes in version E which is before the committee. Anyone wishing to receive a copy of the latest version can contact him at 1-800-465-4939. Number 1185 [HB 186 was held in committee.]
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