Legislature(2011 - 2012)BELTZ 105 (TSBldg)
04/10/2012 01:30 PM Senate LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| HB252 | |
| HB301 | |
| SB128 | |
| SB166 | |
| HB50 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 166 | TELECONFERENCED | |
| + | HB 50 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 252 | TELECONFERENCED | |
| += | HB 301 | TELECONFERENCED | |
| += | SB 128 | TELECONFERENCED | |
SB 166-LABORATORY SCIENCE PROFESSIONAL LICENSING
2:06:40 PM
CHAIR EGAN announced consideration of SB 166, [CSSB 166( ),
labeled 27-LS1163\I was before the committee].
2:07:12 PM
TOM OBERMEYER, staff to Senator Bettye Davis, said SB 166
establishes a seven-member board of clinical laboratory science
professionals that includes one public member, five members that
are licensed by the board (a medical laboratory scientist, a
laboratory technician, a medical laboratory assistant, a
phlebotomy technician, a public health scientist and (in the CS)
a medical laboratory director.
He said that SB 166 requires licensing of medical laboratory
science professionals under Title 8. Today, medicine is a team
effort, which requires the highest quality and coordination of
all occupations in provider services. Most health care
professions are licensed in Alaska to protect the public and
define the scope of practice and training required to engage in
them. However, medical laboratory science professionals and
radiologic technologists are not licensed, yet they perform the
majority of diagnostic testing in Alaska.
MR. OBERMEYER said at least 70 percent of laboratory results are
used for direct patient care, diagnostic, therapeutic or
management decisions and that inaccurate test results by
unqualified medical professionals can delay appropriate care and
lead to inappropriate or harmful diagnoses or treatments that
could result in injury or death. The complexity and importance
of laboratory science in modern medicine makes it necessary that
medical laboratory personnel possess the qualifications
necessary to ensure their professional competence. That is what
SB 166 does. The CS also has transition clauses that provide for
continuing part-time, full-time and non-resident temporary
medical technician workers.
SENATOR PASKVAN moved to bring version CSSB 166( ), version 27-
LS1163\I, before the committee for discussion purposes.
CHAIR EGAN objected for discussion purposes.
MR. OBERMEYER explained that the CS would increase the
composition of the board from five members to seven; the board
will now have five licensed medical laboratory science
professionals, the medical laboratory director and one public
member. Their scope of practice is set out on pages 3 and 4. He
explained that version I of SB 166 increases the initial
staggered terms for three members who will serve three years
instead of two (the previous M version provided for two members
who will serve one year). The number of members on the board was
increased as well as the terms staggered to provide for this
change. The CS also changes the definition of "medical
laboratory science director" to a management director "in charge
of personnel and the performance of laboratory tests" (page 8,
lines 5-8).
MR. OBERMEYER said the medical director also need not be a
licensed allopathic physician, which was required in the
original version but was changed in version M. The CS deletes
the duties of the board to establish continuing education
requirements, because another section (830) of this new chapter
already covers competency. The CS changes responsibility for
examination and licensing from the department to the board.
On page 7, lines 16-18, under the list of exemptions from
license requirements, number (8) specifies that allopathic
physicians or osteopaths with a specialty in pathology will
assist in preparing for postmortem examinations. Number (9)
provides an exemption for a certified cytotechnologist with a
revised list of their duties under the supervision of a
physician or osteopath (page 7, lines 19-20).
Finally, Mr. Obermeyer said, the CS provides grandfathering for
currently employed persons under the applicability section to
the licensing requirement on page 8. Grandfathering is limited
to two years for those employed in the state for three of the
last five years who have documented advanced education, training
and experience in lieu of certification by a national
credentialing agency (page 8, line 30 to page 9, line 7).
The transition section on page 9 says licensing is not required
for up to one year following the effective date of the act for a
half-time worker with at least 1,040 hours of acceptable medical
laboratory testing experience during two of the preceding three
calendar years and who submits the documented job descriptions
for the positions in which he acquired the experience to the
board. It also exempts non-resident workers from certification
or the licensing requirement who come into the state on a
temporary basis for up to 13 weeks in a 12-month period. That
refers back to exemption number (6).
2:14:28 PM
He noted that penalties are not included in either versions I, B
or M, because the boards under Title 8 already have a number of
disciplinary powers including revoking a license and imposing a
civil fine not to exceed $5,000.
2:15:02 PM
SENATOR MENARD asked how many other states require this type of
licensing and if he could share the range of costs for licensing
in other states.
MR. OBERMEYER said he had some of that information in the
office, but the department could better answer those questions.
Alaska has 600 to 900 individuals who would fall under this
proposal, so it shouldn't be an expensive process for them.
SENATOR MENARD said her concern was that medical students incur
a tremendous debt for their schooling, and even if the fee is a
little more than in other states, it would be just one more
negative that would keep someone from coming back to Alaska to
work.
MR. OBERMEYER again said that the department could respond to
that, but his understanding was that this bill avoided a great
number of costs. Because the certifying agencies are outside
Alaska, this board just checks to make sure these people
actually have the hours and qualifications they have submitted,
and then they are licensed or not at that point.
CHAIR EGAN asked Mr. Hurlburt if he could answer any of Senator
Menard's questions.
2:19:34 PM
WARD HURLBURT, Director, Division of Public Health, Department
of Health and Social Services (DHSS), said some of the specific
cost questions could be answered by the Department of Commerce,
Community and Economic Development (DCCED). He appreciated the
intent to assure quality for laboratory testing, but the Center
for Medicare and Medicaid Services (CMMS) states that they
regulate all laboratory testing in the country. A hospital lab,
for instance, goes through a certification process through
either the Joint Commission or the Council of American
Pathologists. He explained that CLIA (Clinical Laboratory
Improvement Amendments) mandate standards for clinical
laboratories in physicians' offices and certain fairly basic
tests can have a CLIA waiver. In his experience, those are not
just paper requirements but real quality requirements. So he
believed that establishing this board could have a potential
adverse impact on small physicians' offices, because it might
increase costs and make recruitment harder.
SENATOR PASKVAN asked what percentage of currently practicing
professionals would have to be brought up to speed in two years.
MR. HURLBURT replied that he didn't have that information
available. Large labs would have the baccalaureate level and
technician level (two-year training) technologists, as well as
laboratory assistants. The state lab is run by a PhD. A small
physician's office would employ people with on-the-job training
who use waivered CLIA tests for competency.
2:23:34 PM
SENATOR GIESSEL asked why these individuals should fundamentally
be licensed.
MR. OBERMEYER answered that it was felt that people are supposed
to have national standards going through this process and that
there really isn't a great deal of control, particularly in
offices that have waiver standards (which tends to be the bulk
of the testing). He wasn't suggesting that they weren't highly
qualified people, but that there are no standards for what they
are supposed to be doing. He had asked Heidi Amen from the DHSS
and Gloria Tomich, University of Alaska Anchorage, to respond to
this issue and to include the number of the types of associate
and bachelor degrees that are required. The concept behind it is
competency and protection of the public.
SENATOR DAVIS added that this bill was requested by those in the
profession and their testimony could shed more light on the
issue.
SENATOR GIESSEL said she would defer to Senator's Davis'
recommendation to hear from those individuals.
2:26:12 PM
GLORIA TOMICH, University of Alaska Anchorage, said because 70
percent of medical decisions are based on laboratory results, an
educated and competent workforce in laboratory testing was
needed. This is accomplished through certification. Licensure
under this bill does require certification. The goal of
licensure is to have more stringent requirements for the
performance of laboratory testing that will reduce laboratory
errors and increase patient safety.
MS. TOMICH said the journal article submitted to the committee
gives examples of laboratory errors, particularly in point of
care testing. Noncertified testing personnel have a higher rate
of error than those who are under the supervision of certified
personnel. She said this will not prevent health care providers
from hiring noncertified staff but it will require oversight of
competency and quality control by licensed personnel who are
certified.
MS. TOMICH said she believed that all medical personnel working
in Alaska should be licensed. It is important for quality
laboratory testing, which ultimately results in better patient
safety. Currently, in Alaska, most health care professionals
except laboratory scientists and radiologic technicians are
licensed.
2:28:17 PM
She said that 13 states have licensure for laboratory
professionals and 25 states are in the process of requiring it.
SENATOR GIESSEL asked why have a board if national certification
by a recognized credentialing agency or organization is the
criteria by which competency is measured. It seems redundant.
MS. TOMICH replied that laboratory professionals are certified
by the national agency and one of this bill's strong points is
that every three years people must provide evidence of
continuing education to maintain their certification. She
explained that laboratory world is very dynamic; it changes all
the time and people need to keep current with it. The current
certification requiring continuing education is sufficient to
support those who are licensed.
SENATOR GIESSEL questioned the need for a regulating board when
Ms. Tomich was already saying that this national organization
certifies competence and continued competence,
MS. TOMICH replied that not all laboratory testing is done by
certified personnel and a large number of errors are made by
people who are not certified.
2:30:52 PM
SENATOR GIESSEL said it's up to the employer to determine the
credentials of the individual they are employing to perform
certain duties and asked in practical application, if she was
requiring that all physician offices hire only certified lab
techs.
MS. TOMICH responded that the bill doesn't require that all lab
techs have certification, but it does require having oversight
of quality control and competency, and a consultant could come
in and do that oversight. It's a closer monitoring of quality
control and competency of the staff that is doing the testing.
She clarified that physician office laboratories do point of
care testing including CLIA waived tests, but a lot of point of
care testing is not waived.
SENATOR GIESSEL said the Joint Commission on Accreditations of
Healthcare Organizations (JCAHO), the national lab certifying
agency, and the CMMS already monitor physician lab operations,
and this is all done to verify validity, and asked if this just
another hoop that adds cost to the health care system and
creates a board that isn't really necessary.
MS. TOMICH replied that the Joint Commission and CLIA regulate
and license laboratories; however, they don't closely monitor
competency, education and continuing education. They don't
require continuing education, and they believe that continuing
education is very important for laboratory professionals. If
someone doesn't know the current protocols, then they won't
perform laboratory testing properly. Again, they have testimony
from people who have talked about a lot of errors in point of
care testing and they are hoping this licensure will cut down on
those errors.
2:34:38 PM
WILLIE RUMBO, representing himself, Anchorage, said he is a
medical technologist and that he opposed SB 166. He agreed that
it would raise costs and create another hoop for medical
professionals to go through just to be able to practice their
jobs. CLIA does create those regulations already; it requires
minimum training and education standards.
The focus seems to be on point of care testing, but CLIA does
require a minimum education standard for that. He explained that
point of care testing not only occurs in doctors' offices, but
at the hospital and in emergency rooms. Will they require
certified technicians to perform testing in emergency rooms and
on the floors in hospitals and say this won't raise the cost of
medicine? That is preposterous, and they are assuming that
everyone who performs point of care testing is somehow
incompetent. Twenty of his colleagues also oppose this. He said
the Food and Drug Administration regulates them and there is
already enough regulation from the federal government.
CHAIR EGAN asked if he thought SB 166 was unnecessary.
MR. RUMBO replied it is very unnecessary. He reiterated that
they are already regulated through the Center for Medicare and
Medicaid Services and by the Food and Drug Administration that
both require minimum education standards for performing his job,
which includes point of care testing.
SENATOR PASKVAN asked what education level he had attained.
MR. RUMBO replied a Bachelor's Degree in Medical Technology.
2:39:21 PM
DON HABEGER, Director, Division of Corporations, Business and
Professional Licensing, Department of Commerce, Community and
Economic Development (DCCED), commented that currently the fee
on page 5, line 9, is established by the division; central
licensing requires annual review of revenue and expenses. He
explained that essentially, the formula for setting fees has to
match approximate revenue and expenses. If the board is setting
those fees, it should have a similar standard. Otherwise it may
not cover expenses and that would make management of the program
difficult.
SENATOR GIESSEL said language on page 5, line 5, identifies a
three-year licensure duration and asked if other licenses are
provided by the division that endure for three years.
MR. HABEGER replied the he administers 40 programs and only one,
the geologist, has a lifetime license; all others have a two-
year bi-annual cycle.
2:41:55 PM
SENATOR MENARD asked if the department had a position on this.
MR. HABEGER replied no.
MR. OBERMEYER said he could see how raising standards could cost
more, but if some of the results are not adequately understood,
then the public is at risk.
CHAIR EGAN thanked them and said he would hold this bill until
the next meeting. He asked Hilary Martin if she had any
clarifications and found she did not have any comment.
[CHAIR EGAN held SB 166 in committee.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 166 email supporting, Bacom 040712.PDF |
SL&C 4/10/2012 1:30:00 PM |
SB 166 |
| SB 166 CS blank ver I.pdf |
SL&C 4/10/2012 1:30:00 PM |
SB 166 |
| SB 166 Compare version B to version I.pdf |
SL&C 4/10/2012 1:30:00 PM |
SB 166 |
| HB 252 Amendment D.2.PDF |
SL&C 4/10/2012 1:30:00 PM |
HB 252 |