Legislature(2005 - 2006)HOUSE FINANCE 519

02/13/2006 01:30 PM House FINANCE


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ HB 150 LICENSING RADIOLOGIC TECHNICIANS TELECONFERENCED
Heard & Held
+ HB 331 UNDERAGE MILITARY ON LICENSED PREMISES TELECONFERENCED
Moved CSHB 331(L&C) Out of Committee
+= HB 334 MUNICIPAL PROPERTY TAX DEFERRAL/EXEMPTION TELECONFERENCED
Scheduled But Not Heard
+ HB 357 STATUTORY REFERENCES TO DISABILITIES TELECONFERENCED
Moved CSHB 357(FIN) Out of Committee
+ Bills Previously Heard/Scheduled 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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