Legislature(2007 - 2008)CAPITOL 17
04/27/2007 03:00 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| HB209 | |
| HB200 | |
| HB71 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 200 | TELECONFERENCED | |
| += | HB 71 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 209 | TELECONFERENCED | |
HB 71 - LICENSING RADIOLOGIC TECHNICIANS 5:19:25 PM CHAIR OLSON announced that the final order of business would be HOUSE BILL NO. 71, "An Act requiring licensure of occupations relating to radiologic technology, radiation therapy, and nuclear medicine technology; and providing for an effective date." [In members' packets was a proposed committee substitute (CS) for HB 71, Version 25-LS0321\E, Bullard, 4/10/07.] 5:19:34 PM REPRESENTATIVE SCOTT KAWASAKI, Alaska State Legislature, sponsor, relayed that in addition to the proposed committee substitute (CS) for HB 71 - Version 25-LS0321\E, Bullard, 4/10/07 - there would be a few amendments forthcoming, and then responded to questions and concerns raised at the bill's prior hearing. With regard to a concern about cost, he said he doesn't believe that HB 71 will be particularly cost prohibitive to those providing radiologic services in Bush communities because the bill contains criteria allowing a person to obtain licensure as a limited radiologic imager. With regard to the question of how many trained radiologic technologists provide services in the Bush, he explained that there are currently 479 registered radiologic technologists in the state, though that number fluctuates from year to year, and that there are an estimated 600-700 untrained individuals in the state most of whom, if not all, would qualify under the limited licensure provisions of [Version E]. REPRESENTATIVE KAWASAKI said that hospitals in Kotzebue, Dillingham, and Nome employ "full" radiologic technologists, and that proposed AS 08.89.150(b)(1) now requires a limited radiologic imager to perform limited radiologic diagnostic imaging only under the "general supervision" of a fully licensed radiographer or a licensed practitioner. With regard to a question regarding continuing education, he explained that continuing education credits are available; that most folks use an online program found on the web site, "glaciermedicaled.com"; and that the American Society of Radiologic Technologists (ASRT) also provides an online program for continuing education credits. With regard to a concern about the updating of radiologic equipment, he relayed that the Alaska State Public Health Laboratories (ASPHL), within the Department of Health and Social Services (DHSS), already addresses that issue, though with limited staff. REPRESENTATIVE KAWASAKI said that both large and small hospitals dealing with the federal Public Health Service (PHS) or Indian Health Service (IHS), and general hospitals in larger cities, are accredited, and the [Joint Commission on Accreditation of Healthcare Organizations (JCAHO)], which deals with larger scale hospitals, maintains accreditation and has strict compliance levels, particularly with regard to radiological equipment. With regard to the question of who supports the bill, he said that the Alaska Society of Radiologic Technologists (AKSRT), the ASRT, the Department of Commerce, Community, & Economic Development (DCCED), the Alaska State Hospital and Nursing Home Association (ASHNHA), and various other groups all support the bill. REPRESENTATIVE KAWASAKI mentioned that other groups such as the Alaska Native Tribal Health Consortium (ANTHC), the Southeast Alaska Regional Health Consortium (SEARHC), and the Alaska Primary Care Association, Inc. (APCA) have expressed concern with some of the provisions of the bill, particularly as they might affect rural communities, and so he will be addressing some of those concerns via amendments. He also mentioned that some groups that have opposed similar legislation in the past now either support HB 71 or are neutral towards it. He indicated that his goal is to get HB 71 passed in a form that will satisfy the concerns of all interested parties and thereby address the existing public safety problem. With regard to the question of why dental assistants are not included in HB 71, he relayed that such persons are already specifically addressed via separate statute and regulations. REPRESENTATIVE KAWASAKI, in response to questions, replied that currently there is no state licensure of those conducting radiologic imaging in Alaska, and that he introduced HB 71 by request because of public health concerns regarding unlicensed and untrained personnel administering radiologic exams. REPRESENTATIVE NEUMAN said he just presumes that healthcare facilities which offer radiologic services have already taken steps to ensure that the employees conducting radiologic exams have received the proper training. REPRESENTATIVE KAWASAKI indicated that such is not the case, and offered as just one example an incident involving the hospital in Juneau wherein patients were subjected to improperly- performed radiologic procedures. In response to another question, he relayed that although he can't speak about other hospitals, the Fairbanks Memorial Hospital & Denali Center requires those performing radiologic procedures to receive certified training from the American Registry of Radiologic Technologists (ARRT). REPRESENTATIVE GARDNER referred to written information from Clyde Pearce - chief of Alaska's Radiological Health Program - provided in members' packets regarding state inspections of radiological equipment and procedures, and noted that this information illustrates that Alaska is behind the times with regard to radiological safety practices. REPRESENTATIVE KAWASAKI, in response to questions, relayed that he was first approached to sponsor HB 71 by a licensed and registered radiologic technologist, and that the goal of the bill is to prevent [further] harm from coming to the people receiving and performing radiological services. 5:35:56 PM CLYDE E. PEARCE, Radiologic Health Specialist II, Radiologic Health, Laboratories, Division of Public Health, Department of Health and Social Services (DHSS), relayed that he is the state's radiation inspector and travels throughout the state performing both state inspections and federal inspections under contract, adding that the federal rules are different than the state's current rules; for example, the federal rules require a level of training for those performing radiologic exams that meets or exceeds that being required by the bill. He gave a brief history of the use of ionizing radiation, remarked that the use of such radiation has been found to be of great benefit - perhaps even contributing to increased life expectancy in the last century - but warned that it has also been clearly found that radiation can cause injury if used in excess. MR. PEARCE said he feels some passion about HB 71 because even though there have been a lot of changes over the years that keep reducing, theoretically at least, the risks associated with the use of radiation, the changes that have occurred in the last dozen years have actually increased those risks. He elaborated: We have two things going on at once: one is that radiation exposures in general are increasing because we have many more ways of using the radiation, and if you use more radiation you can improve the quality of the image, and so we want a good quality image but we don't want any more radiation than is absolutely necessary to get that; and at the same time research that has been done more recently has shown two things, one is that biological effects now are shown to occur at diagnostic levels of exposure, which means it's not just people who got some horrendous amount or some radiation therapy treatment to the breast that get breast cancer, that even at diagnostic levels they're showing some effects, and the other thing is a study by Dr. Pierre Hall from Stockholm, Sweden, ... of about 3,500 adult men who were exposed as infants, and they had a measurable reduction in mental capability - they were less smart as a result of radiation exposure at diagnostic levels. And so, with the fact that we see biological effects occurring at lower levels of exposure, and overall trends of increasing exposure, there's a concern. And in my inspections throughout Alaska - I am the author of that [written information which] Representative Gardner was referring to [and it contains] just some ... representative examples - ... I see a lot of that. For the most part I see the problem as one that's amenable through education [because with] the machine itself, I rarely see an actual problem; I do many different tests, and the machines normally pass most of those tests. What I see most often [are] ... problems with how the machines are used. And I relate that to an automobile, where you're required to have a certain amount of knowledge and you have a skill test and you even have an eye test, and you go out and you drive the automobile, so you would think with our transportation regulations that would be a pretty safe thing - the automobile itself has a lot of safety features built in - and yet we still have over 40,000 people a year who've died. And so what's the problem? It's how the automobile is used - people exceeding the speed limit or going through red lights because, if you look at science, if you go fast enough, a red light does look green, theoretically, and apparently we have some people in Anchorage ... REPRESENTATIVE RAMRAS interjected to question the difference between someone who is trained to used radiologic equipment and someone who is licensed to use radiologic equipment, adding that he presumes a certain degree of competency [in those that are performing radiological exams]. MR. PEARCE characterized that presumption as incorrect: not all who perform radiological exams are trained - many individuals operating the equipment have had no formal education or training in the use of that equipment. He relayed that one of the examples of misuse he'd listed in his written information was one he'd come across while investigating a complaint about that provider's office - the person performing the radiological exams clearly did not know what she was doing and had been given the wrong advice by her supervisor who, theoretically, trained her in the use of the equipment. REPRESENTATIVE RAMRAS said he will be supporting the bill because qualified training is needed for those that operate radiological equipment. 5:43:37 PM DONNA J. RUFSHOLM, R.T., Chair, Legislative Committee, Alaska Society of Radiologic Technologists (AKSRT), relayed that the AKSRT has been working on this legislation for a number of years because it feels strongly that patient health/safety is primary. She said that she has worked at both large and small facilities over the last 23 years, and has seen a number of radiological images come in from sites that don't hire registered radiological technologists or people that have been trained at all, and those images have no diagnostic value whatsoever - they are either too dark or too light or the positioning of the patient is wrong, and so a proper diagnosis cannot be obtained from those images. The AKSRT feels that there is a concern, particularly after becoming familiar with the information provided by Mr. Pearce. MS. RUFSHOLM indicated that that information illustrates that there are people providing radiological services in this state who are not properly trained, people who've been "practicing" on each other, people who've not taken steps to protect themselves. House Bill 71 will provide protection both for patients and for those who operate radiological equipment, and will help ensure that x-rays are taken properly; the way to reach these goals is to license those who provide radiological services. Requiring licensure will ensure that those individuals have received the proper education and credentials to perform radiological procedures. MS. RUFSHOLM said that the AKSRT has suggested that the bill include provisions to ensure that rural areas can continue to provide radiological services; however, it is important that the images produced in rural communities are of a quality that can be used to help determine whether a patient actually needs to be transferred to a larger medical facility. She explained that the AKSRT has taken steps to ensure that providers of radiological services can receive the proper training at a minimum of expense, and has identified online courses that are available. Such courses, she remarked, are available at a cost of $229 - less than the cost of one radiological exam - and currently there are 40 people voluntarily taking the training program that's available through the University of Alaska. In conclusion, she relayed that the AKSRT would like to see HB 71 adopted. 5:47:58 PM RHONDA MERRIHEW, R.T., Co-Chair, Legislative Committee, Alaska Society of Radiologic Technologists (AKSRT), shared an example wherein an individual providing radiological services in a rural area of the state took a whole-body x-ray - without shielding - of a baby that only needed a chest x-ray; that baby received far more radiation than was needed. She also shared an example wherein an individual providing radiological services in an urban area of the state told a physician, "I didn't know what I was doing, so I just aimed for the middle." Ms. Merrihew remarked: "These are things that we would like to see not happen, and ... [the AKSRT wants to ensure] that ... people are not being irradiated unnecessarily." REPRESENTATIVE GARDNER expressed concern that radiological services are being provided [by untrained personnel], adding that she is ready to move the bill from committee. REPRESENTATIVE LeDOUX asked whether patients are notified when the person performing radiological services hasn't done it right. MS. MERRIHEW said those patients have no idea that they were being overexposed. REPRESENTATIVE LeDOUX, referring to the example involving the baby, noted that that baby may have health problems years from now as a result if his/her overexposure. She asked whether there is any way for a person to find out whether he/she has "been the victim of this sort of thing." MS. MERRIHEW said not that she is aware of. [Due to technical difficulties with the microphones, the remainder of Ms. Merrihew's response was not audible.] REPRESENTATIVE NEUMAN asked Ms. Merrihew whether she has seen the letter of opposition to HB 71 provided by the Alaska State Medical Association (ASMA). MS. MERRIHEW said she has not. The committee took an at-ease from 5:54 p.m. to 5:55 p.m. MS. MERRIHEW shared her belief that all residents of Alaska deserve to have safe medical care. The committee took another brief at-ease. 5:56:47 PM PAUL HANSEN, Deputy Administrator, Maniilaq Health Center, Maniilaq Association, relayed that the Maniilaq Association is a tribal organization in Kotzebue; that the Maniilaq Health Center, which is JCAHO accredited, provides medical services to eligible individuals that reside in local tribal communities and in the Northwest Artic Borough; that the medical, clinical, and nursing services provided by the Maniilaq Association are delivered both by the federally owned health center and a network of village health clinics; and that his organization is a co-signer of the "Alaska Tribal Health Compact." He said that his organization generally supports the intent of HB 71, but is concerned that as currently drafted, the bill will negatively impact access to and the level of healthcare that his organization provides to its patients, and that it conflicts with the exemption from state regulations currently provided by the aforementioned compact. MR. HANSEN said that his organization feels that HB 71 should be modified to extend to tribal healthcare providers the same licensure exemption that the bill currently provides to medical personnel in the armed forces and the U.S. Public Health Service (PHS). He relayed that his organization has proposed some language that would extend the exemption to providers in federally owned facilities; specifically, language would be inserted into proposed AS 08.89.100(b) - the exemption provision - such that the licensure requirements would not apply to "a person who is in the direct employment of a tribe or tribal organization for the purpose of carrying out healthcare programs, functions, services, and activities in facilities utilizing connection with a contractor or compact with the Indian Health Service pursuant to Title 1 or 5 of the Indian Self-Determination and Education Assistance Act". MR. HANSEN, in conclusion, said that the Maniilaq [Health Center] opposes the bill without the aforementioned suggested amendment, adding that the Alaska Native Health Board (ANHB) has taken a similar position. CHAIR OLSON asked Mr. Hansen to fax written comments to his office. REPRESENTATIVE LeDOUX indicated that she is planning to introduce an amendment that would read, "(7) in the medical service of or employed by a tribal health organization providing a healthcare service or program of the Indian Health Service while in the discharge of the person's official duties", and asked Mr. Hansen whether this amendment would alleviate his concerns. MR. HANSEN indicated that it would. One reason for including such an exemption, he added, is that the tribal healthcare organization, via the aforementioned compact, is now providing services on behalf of the federal IHS, and as such is entitled to a federal preemption from state regulations. He pointed out, however, that Representative LeDoux's suggested amendment may not necessarily make that point clear. He went on to say that he agrees that ensuring patient safety is very important, and that requiring at least a minimum amount of training prior to providing radiologic services is also important, though the key to providing quality service is to maintain proper oversight and ongoing peer review. 6:06:08 PM S. LYNN HORNBEIN, M.D., relayed that she runs an urgent care clinic in Palmer, and that the clinic has just purchased an x- ray machine. She said she questions how she will be able to afford to keep a full time "radiation tech" on staff, surmising that the average hourly wage for such a person is probably about $30. She also surmised that if she has no one on staff that's allowed to operate the radiological equipment, patients will have to drive to another facility in order to receive radiologic services. She opined that HB 71 will cause treatment to be more expensive and will cause delays in diagnoses. She asked how limited licensure could be obtained by those who already have some experience "shooting films ... in practice," and whether someone seeking limited licensure could receive training while continuing to work full time. In response to a question, she said she supports the idea that individuals performing x-rays should be educated, but she has concerns that the language in the bill may prove limiting to smaller clinics regardless of whether they are in rural areas of the state. CHAIR OLSON suggested that Dr. Hornbein submit her questions to the sponsor's office. 6:09:48 PM SONIA HANDFORTH-KOME, President, Alaska Primary Care Association (APCA); Executive Director, Iliuliuk Family & Health Services, Inc., said that the APCA is not in support of the bill as it is currently written and has concerns that the bill will have significant budgetary impacts on her organizations without guaranteeing safety. She went on to say: We have very stringent safety programs in place in Unalaska, [and] I would be more comfortable with a bill that required that we prove ... our training program when we prove our safety measures and ... quality measures, than with a bill that simply requires education. I have one certified and two uncertified x-ray techs on staff and there is no discernable quality difference between them. In fact, my two uncertified ones have more experience than our, arguably, safer and better [tech] because they're very stringent about how they follow our safety guidelines; we have to pretty much urge our certified one to follow the safety guidelines. MS. HANDFORTH-KOME, in conclusion, reiterated that "we do not currently support" HB 71. CHAIR OLSON, after ascertaining that no one else wished to testify, closed public testimony on HB 71 and relayed that the bill would be held over. [Although the proposed committee substitute (CS) for HB 71, Version 25-LS0321\E, Bullard, 4/10/07, was available in members' packets, no motion was made during this meeting to adopt it as the work draft.]
| Document Name | Date/Time | Subjects |
|---|