Legislature(2003 - 2004)
03/28/2003 03:18 PM House L&C
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* first hearing in first committee of referral
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HB 186-LICENSING RADIOLOGIC TECHNICIANS Number 1576 CHAIR ANDERSON announced that the final 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 1607 The committee took an at-ease from 3:47 to 3:48 p.m. Number 1618 REPRESENTATIVE LYNN moved to adopt the proposed CSHB 186, Version 23-LS0380\S, Lauterbach, 3/25/03, as the working document. There being no objection, Version S was before the committee. Number 1639 CHAIR ANDERSON, as the sponsor of HB 186, explained that members of the [Alaska] Society of Radiologic Technologists approached him last summer about introducing a bill that would license radiologic technicians and create a board of examiners. He said the bill has been introduced several times in the past 10 years. He said he favors careful scrutiny and licensing of people employed in the health care field. He stated that an error by a technician doing a mammogram, for example, could result in overlooking a case of breast cancer. Number 1723 HEATHER BEATY, Staff to Representative Tom Anderson, Alaska State Legislature, summarized the changes in the proposed committee substitute (CS) for HB 186. She said these changes were discussed with staff from the Division of Occupational Licensing. On page 4, line 12, Sec. 08.89.130, new language gives the Radiologic Technology Board of Examiners authority to evaluate educational programs from out of state. The bill's original language required that all applicants for full licensure must have graduated from an in-state educational program. The proposed CS language provides for graduation from any program that the board decides meets the criteria outlined within the section. The change on page 6, line 1-4, Sec. 08.89.160, makes the same revision. MS. BEATY explained that another change on page 7, line 4, Sec. 08.89.180, removes language [in the original bill] pertaining to a lapse in licensure. By removing this subsection, the licensees would be governed by the centralized licensing statute, which allows for a grace period in renewal of licenses and allows the board to charge a late penalty for renewals made after the expiration date. The original language in HB 186 would require a licensee to begin a new application process if there were any lapse in licensure. Ms. Beaty explained that this is consistent with the way other boards in Alaska provide licensure and allows for a small lapse. On page 8, line 10, Sec. 08.89.300, the words "holding a license or permit" are added after "person." Sec. 08.89.330 on 8, starting on line 26, adds language indicating the board's authority to deny an application or renewal of licensure for disciplinary reasons. She explained that this change was made at the request of division officials. The last change on page 10, line 13, adds "dentists" as a "licensed practitioner" qualified to supervise the performance of radiologic examinations by licensees. Number 1929 BARBARA HUFF TUCKNESS, Director of Legislative and Governmental Affairs, General Teamsters, Local 959, Alaska, testified in support of HB 186 and the changes in the proposed CS. She said the Teamsters represent radiologic technologists at hospitals in Homer and Kodiak. The members support the requirement that individuals working in the industry, whether in a hospital or clinic setting, are certified and are therefore able and eligible to perform the tasks, whether it's mammography, MRI or bone density tests. The work is important because physicians use it to make recommendations for the next step in treatment. She said the Teamsters also support the bill from a public health and safety perspective, giving patients the assurance that qualified people are doing the job. Number 2038 CHRISTINE LUNG, Director of Government Relations, American Society of Radiologic Technologists (ASRT), explained that her professional organization was founded to promote the proper and safe delivery of medical imaging and radiation therapy procedures. She said ASRT is concerned about the risks from unnecessary radiation exposure. She stated that 90 percent of public exposure to radiation results from medical procedures, primarily diagnostic x-ray exams performed by radiologic technologists. Ms. Lung stated that the federal Food and Drug Administration, Bureau of Radiologic Health, estimates that 30 percent of exposures to manmade radiation are unnecessary, and 5 to 10 percent of unnecessary exposures are attributed to repeated x-ray exams. She said that ASRT is concerned that overuse as well as the improper use of medical radiation is an ever-increasing health hazard to the public. MS. LUNG testified that currently a physician using x-ray equipment in his practice is under no obligation to require any credential or specific education of the employee who operates medical imaging or radiation therapy equipment. She said in Alaska, anyone off the street can be hired in the morning to operate this potentially dangerous equipment that the afternoon. She said her society believes that HB 186 will help alleviate this disparity in health care. Number 2115 MS. LUNG said there are over 400 radiologic technologists registered in the State of Alaska by a voluntary certification body, the American Registry of Radiologic Technologists (ARRT). However, she said, there's no way of knowing how many people with minimal training and no certification are operating x-ray, radiation therapy, and other medical imaging equipment in Alaska. These people are administering potentially harmful radiation without having demonstrated scientific knowledge, technical understanding, clinical competency, or professional responsibility. She said that 36 other states currently license radiologic technologists and radiation therapists. She said she hopes the State of Alaska will join these other states in making sure that the people performing medical imaging and delivering radiation therapy are properly educated and credentialed, as evidenced by being licensed. Number 2172 REPRESENTATIVE ROKEBERG asked whether the federal Consumer- Patient Radiation Health and Safety Act of 1981 requires workers in the field to be certified. MS. LUNG responded that this federal law sets voluntary standards for the states. She said that HB 186 would meet these voluntary requirements. She said that her organization and 16 other national societies representing radiation and medical imaging personnel are pursuing an amendment to the 1981 federal law, H.R. 1214. This amendment would require states to comply with the law's mandates at the risk of losing state Medicaid matching funds for radiologic procedures. REPRESENTATIVE ROKEBERG asked questions about whether the ASRT provides educational courses or certifications. MS. LUNG replied that the ASRT does not provide courses for people entering the profession but it does do continuing education training for registered radiologic technologists. She explained that it does not offer certifications; rather it represents professionals in the field. She explained that a national agency, the ARRT, provides the examination and credentials. Number 2289 REPRESENTATIVE GUTTENBERG asked if HB 186 meets a national standard or conforms to other state's norms for radiologic technologists. MS. LUNG replied yes. Number 2352 DONNA RUFSHOLM, President, Alaska Society of Radiologic Technologists, reiterated why the Alaska organization requested Representative Anderson to sponsor HB 186. She said that HB 186 ensures that Alaskans will have access to safe and high-quality radiologic care without geographical limitations. She cited the problems identified in the written testimony submitted by the State of Alaska's radiologic health specialist. These examples included operators exposing patients to as much as 60 times more radiation than necessary for medical procedures; operators who practice by exposing each other to x-rays; unrestricted x-ray beams; inexperienced, untrained and under-trained personnel performing radiologic procedures on patients. TAPE 03-24, SIDE B Number 2379 MS. RUFSHOLM stated that many patients assume that people performing medical procedures know what they are doing. She said that licensure through HB 186 will give Alaskans the confidence that they'll have access to high quality radiologic care whenever they go into a facility for an x-ray. Number 2330 REPRESENTATIVE DAHLSTROM asked about the cost of the licensing. CHAIR ANDERSON explained that the fiscal note would be discussed after the witnesses testify. REPRESENTATIVE ROKEBERG inquired about the availability of trained personnel, particularly in rural Alaska. He asked whether the bill allows a multi-tiered level of licensure that would assist people at the entry level of the profession. MS. RUFSHOLM explained that the University of Alaska Anchorage (UAA) has a 19-month associate degree program in radiologic technology. UAA is also working with the society to develop a program for limited licensure so that individuals in rural areas can perform radiologic procedures safely and with confidence. Number 2238 DALE COLLINS, Program Chair, Radiologic Technology, Medical Imaging Sciences Department, University of Alaska Anchorage, described the program that started in 2001 for career-entry radiographers. Currently, 27 students are enrolled in the program, seven of whom will graduate in May as qualified radiographers. They will have the education stipulated by the ASRT and well as the competency requirements determined by the national registry organization, the ARRT. There are classes at UAA and at the University of Alaska Fairbanks. MR. COLLINS said that UAA will soon offer a four-month semester- long program, which includes three courses that would cover all the elements necessary for a limited scope of practice license developed by the ARRT. This program would fill a training need for staff in rural communities around the state. This program could be implemented if HB 186 passes the legislature. Number 2135 REPRESENTATIVE ROKEBERG asked whether developing the four-month program depends on passage of this bill. MR. COLLINS explained that implementing this curriculum is independent of passage of HB 186. REPRESENTATIVE ROKEBERG asked whether most health service providers that hire people in this field require ARRT certification. MR. COLLINS said that certification of radiologic technologists is usually required by the providers' accrediting organization. For example, JCAHO, the Joint Commission on Accreditation of Healthcare Organizations, requires hospitals to employ ARRT- registered technologists. REPRESENTATIVE ROKEBERG asked about the impact of a $543 license biennial fee on an entry-level technologist. Number 2081 MR. COLLINS replied that an entry-level wage for a radiographer ranges from $36,000 to $40,000. He said the graduates of the UAA program will earn a minimum of $40,000 annually in the Anchorage area. Number 2002 REPRESENTATIVE DAHLSTROM said she found answers to her question about the cost of licensing on the fiscal note. She noted her concerns about limited licenses for those practicing in the rural communities but said she is confident that the next committee of referral, the House Health, Education and Social Services Standing Committee, will carefully review this issues. REPRESENTATIVE ROKEBERG asked if the bill requires the Division of Occupational Licensing to implement regulations for the licensing of radiologic technologists. Number 1967 RICK URION, Director, Division of Occupational Licensing, Department of Community & Economic Development, replied yes. When asked whether his staff has discussed doing advance work on these regulations, given the bill's effective date of July 1, 2003, he answered no. REPRESENTATIVE ROKEBERG suggested that the division consider such advance work, if given authority to proceed by the Legislature. He suggested that the bill has not moved in past years because of its large fiscal note. He noted that its chances may be improved because a law passed several years ago allowing license fees to be treated as program receipts. He noted that the fiscal note and license fee of $543 is based on 400 people becoming licensed. He commented that occupations which are regulated by boards generally have high overhead. CHAIR ANDERSON advised that members of the Alaska Society of Radiologic Technicians agreed to the $543 license fee. REPRESENTATIVE ROKEBERG asked why HB 186 is necessary if the ARRT is already certifying radiologic technologists. Number 1800 MS. RUFSHOLM responded that the registry is a nationally recognized board. Individuals sit for the ARRT exam after they have finished their education and their clinical training to become radiologic technologists. This a voluntary exam, and the person must meet certain educational criteria to be able to sit for this exam and become certified. The individuals who practice in the rural areas without proper education or credentialing cannot even consider sitting for the ARRT exam. REPRESENTATIVE ROKEBERG said he appreciates these efforts to protect the public. Because of the realities of rural Alaska, this bill could limit services by medical providers in rural Alaska. Number 1725 MS. RUFSHOLM said her group's intent is not to bar health services in the rural areas. She explained that the Alaska society is asking that those individuals who are taking x-rays in the rural areas get some sort of education so they understand what they are doing. She stated that radiation is accumulative; it's a health hazard if not administered properly. She said that's why the UAA is working with her society to offer training for a limited license. The intent is not to require an associate degree for everyone working in the field. REPRESENTATIVE ROKEBERG asked if having every operator in the state register with the ARRT would accomplish the same thing. He asked why create a board; why not require everyone who operates a machine to be certified. Number 1646 MS. RUFSHOLM said there are other options besides creating a board. For example, another approach is having the state's radiation health office regulate radiologists. MS. LUNG said that some states require a radiologic technologist to be registered with the ARRT, rather than having a professional board oversee them. Another option is requiring regular inspections of x-ray machines on a regular basis. She said patients in outlying areas of Alaska are entitled to the same quality of care that they would receive in an urban hospital from a registered radiologic technologist. She emphasized that radiologic procedures are not only done in a hospital; 40 percent are done in an outpatient setting or in a physician's office. These facilities don't have the same JCAHO requirements of hospitals. Number 1516 REPRESENTATIVE DAHLSTROM moved to report the CS for HB 186, Version 25-LS0380\S, Lauterbach, 3/25/03, out of committee with individual recommendations and the accompanying fiscal notes. There being no objections, CSHB 186(L&C) was reported from the House Labor and Commerce Standing Committee.
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