Legislature(2005 - 2006)HOUSE FINANCE 519
02/13/2006 01:30 PM House FINANCE
| Audio | Topic |
|---|---|
| Start | |
| HB331 | |
| HB357 | |
| HB150 |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 150 | TELECONFERENCED | |
| + | HB 331 | TELECONFERENCED | |
| += | HB 334 | TELECONFERENCED | |
| + | HB 357 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE BILL NO. 150
"An Act requiring licensure of occupations relating to
radiologic technology, radiation therapy, and nuclear
medicine technology; and providing for an effective
date."
2:40:28 PM
Representative Stoltze MOVED to ADOPT the Committee
Substitute (CS) for HB 150, labeled 24-LS0470\N, Mischel,
2/9/06. There being NO OBJECTION, it was so ordered.
HEATH HILYARD, STAFF, REPRESENTATIVE TOM ANDERSON, explained
that the bill establishes a full licensure for radiological
technicians and a partial licensure for limited radiologic
imagers. Mr. Hilyard related that the new CS removed
language from House Judiciary Version U. On page 2, lines
20-23 of Version U were removed because licensed
practitioners already have no restrictions on the ability to
perform x-ray examinations for diagnostic purposes.
Mr. Hilyard explained that in Version N, page 4, lines 24-
27, the language regarding limited radiologic imagers, was
changed to stipulate a requirement of two years of clinical
experience. Two years was chosen because the bill has a
two-year delayed effective date. Anyone performing these
duties, from the time the bill passes until the time the law
becomes effective, would qualify for the applied experience
and would not need to enroll in a new program.
Mr. Hilyard related that the third change is on page 5,
beginning on line 18 of Version N, "or if the program is
instructed by and under the supervision of a fully licensed
radiographer or licensed practitioner and sponsored by a
medical facility, as defined in AS 18.26.900". The language
was added due to a concern that there are a number of
facilities in rural Alaska that are providing training
programs that would not qualify under the earlier
definitions. This language clarifies that any facility
providing training under the supervision of a radiologist or
a licensed practitioner is acceptable. The intention of the
new language is to address concerns brought by practitioners
in rural Alaska.
2:45:50 PM
Representative Kerttula asked where the licensed
practitioner language was changed. Mr. Hilyard referred to
Version U, page 2, line 5, and lines 20-23, to clarify which
language was removed.
Representative Stoltze requested information about serious
health risks. Mr. Hilyard referred to two articles in the
members' packets, a report from the University of
California, Berkley (copy on file), and a story from the
Sacramento Bee (copy on file), which offer evidence of over-
exposure to radiation through standard medical x-rays.
Mr. Hilyard read from the Berkley report:
"There is the assumption that, at these doses,
radiation doesn't make a significant contribution," he
said. "But x-rays are very potent mutagens, even at
low doses. It's a disaster that people still believe
the `safe dose myth', that low doses are harmless".
Representative Stoltze wondered what motivated the sponsor
to write this bill. Mr. Hilyard reported that he does not
know why Representative Anderson took this subject on.
Representative Foster inquired if the bill applies to dental
x-ray technicians. Mr. Hilyard replied that it does not.
2:50:38 PM
Representative Weyhrauch inquired which groups are in favor
of the bill. Mr. Hilyard replied that the Alaska
Association of Radiologic Technicians, the Alaska State
Hospital Nursing Association, and the Alaska State Medical
Association support HB 150. The language for the bill was
taken from the American Association of Radiologic
Technicians who is leading the movement for licensure.
There are 41 states that currently have licensures.
Representative Weyhrauch inquired how many people would lose
their jobs if the bill passes. Mr. Hilyard reported that he
couldn't answer that question definitively. Great measure
has been taken to try to prevent job loss. There is a two-
year effective date and temporary permits to allow people
time to pass the examination. Most of the people acting as
full radiographers today already have a certification from a
national organization and would only have to pass a state
exam.
2:52:36 PM
Representative Weyhrauch asked how many complaints have been
lodged because of the current situation. Mr. Hilyard
responded that he did not know of any.
Representative Weyhrauch asked why the legislation is
needed. Mr. Hilyard related that it is a serious public
health issue and technicians need training to operate
safely.
Co-Chair Meyer noted that the training could be done on-
line. Mr. Hilyard agreed. He explained that there is a
training program available from Washington for $229. The
additional change in the bill states that any facility in
the state with a program taught by a radiographer or doctor
would also qualify.
2:54:13 PM
Representative Kerttula noted a letter in members' packets
from the Alaska State Medical Association (ASMA) that states
they would prefer and registration system, rather than
licensure. She wondered if ASMA has since changed this
opinion. He noted that he has been working all along with
ASMA. He asked that Mr. Jordan, president of ASMA, respond
to that question at a future date.
2:55:09 PM
Representative Kerttula said she understood the alarm about
unneeded x-rays. She asked for more information from ASMA.
Representative Holm asked why dental technicians do not need
to be registered. Mr. Hilyard replied that dental x-rays do
not present nearly the carcinogenic effect as standard x-
rays. They represent roughly 1/10 the level of exposure.
2:56:45 PM
MIKE FORD, ALASKA NATIVE HEALTH BOARD, JUNEAU, testified in
opposition to HB 150. He addressed costs to rural Alaska.
He pointed out that there have no complaints in Alaska to
date. The current system is very expensive and the proposed
legislation will increase that cost. The legislation adds
requirements to those already trained. To add another
licensing requirement raises issues of access, disruption in
services, and cost.
Mr. Ford mentioned the possible danger of exposure for
dental hygienists. He credited Representative Anderson for
attempting to make the legislation "user friendly". The
bottom line is it is another expense passed on to the
client.
Representative Stoltze commented on a complaint by a
constituent regarding costs to tele-medicine in rural areas.
Mr. Ford replied that this legislation would disrupt tele-
medicine and tele-radiology.
Representative Stoltze offered that in the zeal to over-
protect, some services may be denied. Mr. Ford acknowledged
that the motivation for the legislation is good. However,
there will be a layer of additional licensing; in the rural
setting, it will be a significant cost.
3:01:36 PM
Representative Hawker referenced the newly adopted committee
substitute and asked if Mr. Ford agreed that the
incorporated changes would be helpful to rural areas. Mr.
Ford stated that the legislation is user friendly, but the
reality is there will be additional costs to the client.
Representative Hawker asked Mr. Ford if he would have a
different opinion of the bill if it were limited to dealing
with the radiologic technologist. Mr. Ford stated it
"might" change his opinion.
Representative Hawker asked if the argument was about
performing x-ray services as opposed to those people
administering nuclear medicine. Mr. Ford replied that would
relieve some of the concerns.
3:03:53 PM
CLYDE PEARCE, RADIATION INSPECTOR, DIVISION OF PUBLIC
HEALTH, LABORATORIES, RADIOLOGICAL HEALTH, DEPARTMENT OF
HEALTH AND SOCIAL SERVICES, ANCHORAGE, disagreed with Mr.
Ford. He apologized that he had not provided back up
material on the number of complaints lodged. He related
several personal experiences when he inspected medical
clinics. He listed several problems with poor training. He
voiced support of HB 150.
Representative Kerttula referred to a handout provided to
the committee about proper training. She asked how many
people operate out of Mr. Pearce's office. He explained his
set up as the only radiation inspector for the State of
Alaska. Representative Kerttula asked if more inspectors,
plus better education, or a system to track the number of x-
rays might be better than legislation for licensure. He
discussed lack of adequate training. Mr. Pearce explained
that 40 percent of repeat exposures were due to mis-
positioning of patient. He spoke of the latent affect of
exposure to radiation and pointed out that few practitioners
recognize a radiation injury.
Representative Hawker asked for Mr. Pearce's affiliation.
He replied that he is the Chief of Radiologic Health for
the Department of Health and Social Services.
3:15:12 PM
DR. WILLIAM W. RESINGER, RADIOLOGIST, MATSU, spoke in
support of HB 150. He pointed out that there is a balance
between the benefits and the risks of employing ionizing
radiation for medical diagnosis. Education and experience
are needed to maintain this balance. A limited radiographic
imager should have the basic training and experience, which
the bill proposes. HB 150 is not designed to burden medical
providers, but to assure that minimum standards are met.
Dr. Resinger shared that, as a radiologist, he would not be
the person to train or supervise medical personnel in modern
medical therapy or surgery. Neither should a physician
train or supervise medical imagers. He defined a "blind
spot" as a problem, which one cannot see. He speculated
that if he misses an abnormality on a radiograph, that
finding becomes a blind spot. Radiologists are constantly
fine-tuning their skills in order to reduce missed
diagnoses. There are occasional abnormalities missed on
radiographs performed in remote areas. Sometimes the
problem is the quality of the image. Compliance to national
standards can be burdensome, but when criteria are
reasonable, the extra effort is worth improving the standard
of care. Dr. Resinger opined that the proposed requirements
of HB 150 are reasonable and should result in a beneficial
effect. He stated a belief that the bill would reduce
"blind spots" in Alaska's medical imaging community.
Representative Hawker asked for clarification of the line
between preparing the image vs. interpreting the image. He
wondered if this bill would license limited radiologic
technicians to read the images. Dr. Resinger said the
radiologists would do that. Representative Hawker asked
about the burden on rural Alaskan providers. Dr. Resinger
noted that there have to be minimum standards balanced with
reasonable regulations. Representative Hawker asked if
there is a legitimate risk to address and a need to
establish regulations. Dr. Resinger elaborated on past
diagnostic concerns.
3:22:19 PM
DONNA ELLIOT, ALASKA NATIVE TRIBAL HEALTH CARE (ANTHC),
agreed with Mr. Ford's comments. ANTHC is a network of
tribes which ensures that all Alaska Natives have health
care. She noted that it is difficult to retain qualified
licensed x-ray technician staff in rural areas. HB 150 is a
concern for ANTHC because it would place an unnecessary
burden on x-ray technicians within the tribal health system.
Representative Joule asked what the impact of this
legislation would be to the delivery system in rural Alaska.
Ms. Elliot replied that it would negatively impact the
delivery of health care because it means another hoop to
jump through. Representative Joule asked if it would impact
the workforce. Ms. Elliot replied that it would.
Representative Hawker asked if there is a distinction
between urban and rural service deliveries. He wondered if
ANTHC's concerns would be alleviated if, in the exemption
section, radiologic imaging would remain under current
statute on an unregulated basis in rural Alaska. Ms. Elliot
agreed that would be a step forward.
Representative Joule asked why the current rural workforce
should not be licensed and more qualified. Ms. Elliot
responded that would be a positive situation.
3:29:47 PM
DONNA RUFSHOLM, CHAIR, ALASKA SOCIETY OF RADIOLOGIC
TECHNOLOGISTS, Homer, shared that her organization helped to
write HB 150. She elaborated on why minimum standards and
additional training are needed. She mentioned the
carcinogenic qualities of radiation of which the average
patient is unaware. She referred to a handout on misuse of
radiation in Alaska (copy on file.) Blame should not be put
on the uneducated operators for radiation errors. They have
not been required to receive the correct training. She
argued that on-line training for $229 is not a financial
burden. HB 150 will not change how small businesses and
rural clinics operate. There are provisions in the bill for
rural area concerns.
Representative Holm referred to earlier testimony about
dental technicians and the comment that they were not
working with a high enough dosage. He inquired about the
carcinogenic effects of low doses. He also wondered about
no reported cases of damage.
Ms. Rufsholm stated that dentists and hygienists are
regulated under separate statutes. She said she hopes there
is never a case of dental-related radiation damage. Future
cases would be hard to track because there is a latent
effect. There have been misdiagnosed cases that cannot be
reported. She hoped that HB 150 would protect both the
patient and the technician.
3:37:44 PM
Representative Hawker commented on various categories of
risk. He inquired where the delineation is between low and
high risk factors. He asked about basic X-rays. Ms.
Rufsholm gave examples of high and low risk procedures.
Rural areas lack sophisticated equipment used for CT's and
MRI's, and only general radiological procedures are seen in
the clinics.
Representative Hawker asked if basic x-rays could be
permitted without additional training. Ms. Elliot cited her
experience with untrained technicians and said she could not
support that idea. Representative Hawker referred again to
the basic level of x-ray and asked why there is such strong
opposition. Ms. Elliot emphasized a need for high standards
of education, no matter where the service is performed. She
highlighted strong points in the bill; it would create more
jobs, and rural jobs would not be lost. She reported that
it is hard to understand why this bill would be opposed.
3:47:43 PM
Co-Chair Meyer announced that HB 150 would be held over.
SHELLY HUGHES, ALASKA PRIMARY CARE ASSOCIATION (APCA),
MATSU, spoke of the health centers located in rural areas of
the state. She read from a letter sent to the members of
the committee (copy on file.) She related that APCA has
been monitoring HB 150 to make sure that rural sites would
not face hardships as a result of the bill. She suggested
that other methods, such as onsite quality assurance checks
be taken to ensure safety improvements, rather than
licensing. She thanked the bill's sponsor for reworking the
bill to better accommodate community health centers.
Ms. Hughes turned attention to page 6, lines 9 and 13. She
suggested a change from "one" to "two" in section (b). She
requested that the Committee carefully weigh the safety vs.
access issues of the bill and address the disparity in
temporary permits.
3:51:24 PM
BARBARA HUFF TUCKNESS, DIRECTOR OF GOVERNMENTAL AND
LEGISLATIVE AFFAIRS, TEAMSTERS LOCAL 959, spoke in support
of CSHB 150. She stated that she represents radiologist
technologists in Homer who are already required by the
hospital to be certified. Certified nursing assistants and
truck drivers are required to have a license. This bill
would provide certification that ensures that the training
is done at the same level and that the service is
consistent. The bill has gone through many renditions. In
response to Representative Hawker's question, she noted that
there is career ladder training, which allows for multiple
levels of training.
Representative Hawker reported that the strongest opposition
to the bill was from the Alaska Academy of Physician
Assistants. He questioned why they were not here to
testify.
3:56:23 PM
LOUANNE CHRISTIAN, STAFF, HOUSE FINANCE COMMITTEE, informed
the Committee that Mr. Hall from the Alaska Academy of
Physician Assistants wanted to testify but was unable to.
Representative Hawker asked that he be present at the next
hearing.
Representative Kelly noted that Don Smith who is strongly
opposed to this bill should also be invited to speak. Co-
Chair Meyer said he is not in agreement with requesting more
public testimony. Representative Kelly stated that he is
concerned about costs and lack of depth of experience in
rural areas. He requested more information and discussion
of the bill.
HB 150 was heard and HELD in Committee for further
consideration.
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