Legislature(2005 - 2006)CAPITOL 120

02/03/2006 01:00 PM House JUDICIARY


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01:12:45 PM Start
01:13:35 PM Commission on Judicial Conduct
01:35:48 PM Violent Crimes Compensation Board
01:39:46 PM HB318
03:13:16 PM HB150
05:15:57 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Confirmation Hearings TELECONFERENCED
-Commission on Judicial Conduct
-Violent Crimes Compensation Board
*+ HB 353 SENTENCING FOR SEXUAL OFFENSES TELECONFERENCED
<Bill Hearing Canceled>
+= HB 318 LIMITATION ON EMINENT DOMAIN TELECONFERENCED
Moved CSHB 318(JUD) Out of Committee
<Bill Hearing Rescheduled from 02/01>
+= SB 132 HUMAN RIGHTS COMMISSION TELECONFERENCED
Scheduled But Not Heard
<Bill Hearing Rescheduled from 02/01>
+= HB 150 LICENSING RADIOLOGIC TECHNICIANS TELECONFERENCED
Moved CSHB 150(JUD) Out of Committee
<Bill Hearing Rescheduled from 02/01>
+= SB 172 INITIATIVE/REFERENDUM BALLOT SUMMARY TELECONFERENCED
Scheduled But Not Heard
+= Bills Previously Heard/Scheduled TELECONFERENCED
HB 150 - LICENSING RADIOLOGIC TECHNICIANS                                                                                     
                                                                                                                                
3:13:16 PM                                                                                                                    
                                                                                                                                
CHAIR McGUIRE  announced that the  final order of  business would                                                               
be  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."    [Before  the   committee  was  the  proposed                                                               
committee  substitute  (CS)  for  HB  150,  Version  24-LS0470\S,                                                               
Mischel, 4/11/05,  which had  been adopted as  the work  draft on                                                               
4/11/05.]                                                                                                                       
                                                                                                                                
HEATH  HILYARD,  Staff  to Representative  Tom  Anderson,  Alaska                                                               
State Legislature,  sponsor, relayed on behalf  of Representative                                                               
Anderson that committee packets  contain a new proposed committee                                                               
substitute  (CS)  for  HB   150,  Version  24-LS0470\R,  Mischel,                                                               
1/12/06.                                                                                                                        
                                                                                                                                
REPRESENTATIVE ANDERSON, speaking as  the sponsor, moved to adopt                                                               
the  proposed  CS  for  HB  150,  Version  24-LS0470\R,  Mischel,                                                               
1/12/06, as the work draft.   There being no objection, Version R                                                               
was before the committee.                                                                                                       
                                                                                                                                
MR. HILYARD  remarked on  some of  the language  in Section  2 of                                                               
Version  R  that  is  identical  to  language  in  Section  2  of                                                               
Version S:     proposed  AS  08.89.100(b)(1)-(4);   and  proposed                                                               
AS 08.89.150(a)(3), which  he suggested may allow  those in rural                                                               
areas  to  substitute  sufficient   experience  for  an  approved                                                               
program  when seeking  to  be licensed  as  a limited  radiologic                                                               
imager -  all persons seeking  such licensure will still  have to                                                               
pass an examination as set forth in the bill.                                                                                   
                                                                                                                                
REPRESENTATIVE ANDERSON concurred.                                                                                              
                                                                                                                                
3:19:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WILSON  opined  that  some  of  the  older  x-ray                                                               
machines in  rural areas are  not going  to be familiar  to those                                                               
currently  taking classes  in this  field; conversely,  those who                                                               
know how  to use such machines  competently might not be  able to                                                               
pass the proposed exam.                                                                                                         
                                                                                                                                
MR. HILYARD surmised that such  older technology would require an                                                               
even  higher level  of  proficiency.   He  suggested that  others                                                               
could better address Representative Wilson's concerns.                                                                          
                                                                                                                                
3:21:06 PM                                                                                                                    
                                                                                                                                
CHAIR  McGUIRE  noted  that  the  reason the  bill  was  given  a                                                               
referral to  the House Judiciary  Standing Committee  was because                                                               
it  includes prohibition,  penalty, and  disciplinary provisions,                                                               
which  start on  page 7,  line 28.   She  asked the  committee to                                                               
focus on the  issues of whether the penalties,  both criminal and                                                               
civil,  are appropriate,  and whether  violations warrant  a jury                                                               
trial.  She suggested that  those who have been giving radiologic                                                               
exams without  any formal education  in this field will  not like                                                               
the  idea of  having  to go  to  school, take  an  exam, and  get                                                               
licensed.                                                                                                                       
                                                                                                                                
MR.  HILYARD,   in  response  to   a  question,  said   that  the                                                               
presumption  is  that those  being  exempted  from the  licensing                                                               
requirements  -  those  listed  in  proposed  AS  08.89.100(b)  -                                                               
already have  a minimum level  of training in medicine  and human                                                               
physiology and anatomy, and so  even though that training may not                                                               
specifically pertain to radiologic issues,  it was felt that that                                                               
training is  sufficient to mitigate concerns  [regarding the risk                                                               
of subjecting someone to] radiation overexposure.                                                                               
                                                                                                                                
[Chair   McGuire  turned   the  gavel   over  to   Representative                                                               
Anderson.]                                                                                                                      
                                                                                                                                
REPRESENTATIVE   GARA   expressed   dissatisfaction   with   that                                                               
reasoning.                                                                                                                      
                                                                                                                                
REPRESENTATIVE   ANDERSON,  referring   to  the   students  being                                                               
exempted  via  proposed  AS   08.89.100(b)(4),  posited  that  an                                                               
[instructor or]  physician will be  monitoring their work  in the                                                               
schools listed; a student shouldn't  have to first be licensed in                                                               
order  to learn  how to  operate the  equipment that  the license                                                               
pertains to.                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARA opined that at  least a competency test ought                                                               
to be required.                                                                                                                 
                                                                                                                                
MR. HILYARD noted  that the list of those being  exempted has not                                                               
been  changed in  Version  R, and  reiterated  his argument  that                                                               
those being exempted  will be assumed to have a  minimum level of                                                               
training in medicine and human physiology and anatomy.                                                                          
                                                                                                                                
3:31:20 PM                                                                                                                    
                                                                                                                                
DONNA  J.  RUFSHOLM,  R.T., Chair,  Licensure  Committee,  Alaska                                                               
Society  of  Radiologic  Technologists  (AKSRT),  confirmed  that                                                               
those  students being  exempted via  proposed AS  08.89.100(b)(4)                                                               
would  be working  under  the direct  supervision  of a  licensed                                                               
practitioner or a licensed radiologic  technologist and would not                                                               
be  working  independently  while   going  through  the  training                                                               
process.   As  long as  a person  is enrolled  in a  program, she                                                               
relayed,  the AKSRT  doesn't feel  that  limited scope  licensure                                                               
would  be necessary  at  the  time the  person  is attending  the                                                               
program, though it  certainly would be necessary  once he/she has                                                               
finished the program if he/she  is not specifically exempted from                                                               
licensure via other provisions in the bill.                                                                                     
                                                                                                                                
[Representative Anderson returned the gavel to Chair McGuire.]                                                                  
                                                                                                                                
REPRESENTATIVE GARA  opined that  dental assistants  and students                                                               
should  not  be exempted  from  licensure  unless the  radiologic                                                               
exams  they  are  conducting  are   occurring  under  the  direct                                                               
supervision of [a licensed radiologic technologist].                                                                            
                                                                                                                                
MS. RUFSHOLM said she didn't  have a problem with adding language                                                               
to that effect.                                                                                                                 
                                                                                                                                
REPRESENTATIVE WILSON  indicated that it is  disconcerting to see                                                               
that licensed  practitioners are being exempted  since they often                                                               
don't always have  any knowledge of radiologic  equipment, and to                                                               
see  that  students  under  the   supervision  of  such  licensed                                                               
practitioner would be exempt.                                                                                                   
                                                                                                                                
CHAIR  McGUIRE  suggested  that  to require  a  physician  to  be                                                               
licensed  in  every little  "subset"  of  medicine would  be  too                                                               
cumbersome.                                                                                                                     
                                                                                                                                
MR.  HILYARD  in  response  to   a  question,  pointed  out  that                                                               
currently there  is no standard  of competency, for  anyone, with                                                               
regard to conducting radiologic exams.                                                                                          
                                                                                                                                
REPRESENTATIVE  ANDERSON noted  that  receiving  either too  much                                                               
radiation or too  little radiation poses a danger  to the public,                                                               
recounted several of the other  groups of people who are required                                                               
by  the state  to be  licensed in  their field  of practice,  and                                                               
opined  that  the state  should  move  ahead  with some  sort  of                                                               
licensure   requirements   for    performing   radiologic   exams                                                               
regardless of  the [continuing] reluctance  of certain  groups to                                                               
comply with the proposed standards.                                                                                             
                                                                                                                                
3:39:37 PM                                                                                                                    
                                                                                                                                
ED HALL,  P.A., Legislative Liaison, Alaska  Academy of Physician                                                               
Assistants  (AKAPA), characterized  the  bill  as confusing,  and                                                               
remarked that in general, physician  assistants do not agree that                                                               
basic  radiology  has presented  a  problem  because no  one  has                                                               
presented any such data.  The  AKAPA can't support HB 150 because                                                               
it is being  presented that providers in clinics  are shooting x-                                                               
rays without any training; however,  the AKAPA has questioned its                                                               
members and  found that every  clinic it has discussed  this bill                                                               
with has  some form of training  program in place.   He suggested                                                               
that  those   who  perform  computed  tomography   (CT)  imaging,                                                               
magnetic  resonance  imaging  (MRI),   and  other  more  invasive                                                               
radiography procedures  ought to receive formalized  training and                                                               
be  subject to  licensure, but  the bill  should be  changed such                                                               
that  those who  "shoot x-rays"  needn't receive  training beyond                                                               
what they  are receiving  on the  job and  needn't be  subject to                                                               
licensure -  such requirements  could prove  onerous particularly                                                               
for those practicing in rural areas of the state.                                                                               
                                                                                                                                
CHAIR  McGUIRE said  her concern  revolves around  the fact  that                                                               
currently,  anyone   can  operate  x-ray  machines   without  any                                                               
training, regulation,  or licensure  even though  overexposure to                                                               
radiation can have severe consequences.                                                                                         
                                                                                                                                
MR. HALL noted that most  physician assistant (PA) programs train                                                               
PAs how  to read x-rays but  not how to operate  x-ray equipment.                                                               
He  concluded by  saying that  the AKAPA  is happy  that PAs  are                                                               
exempt from  the licensure requirements  of HB 150, but  there is                                                               
the perception that the bill could be improved.                                                                                 
                                                                                                                                
3:44:50 PM                                                                                                                    
                                                                                                                                
CHRIS DEVLIN, Executive Director,  Eastern Aleutian Tribes, Inc.,                                                               
relayed that  his organization  has nine  clinics, four  of which                                                               
have x-ray  [equipment], out  in the  Aleutian Islands,  and that                                                               
most x-rays  are being  performed by people  who would  be exempt                                                               
under the bill.  He said the  penalties proposed by HB 150 seem a                                                               
little steep  and he is not  in favor of the  bill moving forward                                                               
as  currently written.   He  asked whether,  if the  bill passes,                                                               
there would  be additional penalties  such as not  qualifying for                                                               
"federal tort coverage."   He relayed that  his organization does                                                               
eventually  send  it employees  out  for  training and  meanwhile                                                               
people are shown  at the work site how to  operate the equipment,                                                               
and  so  he  not  sure  that  there is  a  great  need  for  this                                                               
[legislation].    He  opined  that although  the  bill  has  been                                                               
improved, it will have a  negative impact on rural clinics, which                                                               
will  be faced  with the  question  of whether  to provide  x-ray                                                               
service at all.                                                                                                                 
                                                                                                                                
3:47:39 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  conducts                                                               
inspections of  radiology equipment  for the  state.   During his                                                               
inspections,  he   said  he  has   observed  many   instances  of                                                               
alarmingly high  exposure to radiation,  one in which  the person                                                               
was  trained   by  someone  with  absolutely   no  background  in                                                               
radiology and told the person to  do exactly the opposite of what                                                               
was  correct.   He relayed  that the  DHSS favors  protecting the                                                               
public  from exposure  to excessive  radiation,  and offered  his                                                               
belief that training  is important and that it  is also important                                                               
for that  training to be  conducted by  those who know  what they                                                               
are  doing.    In  conclusion,  he  characterized  the  penalties                                                               
proposed by the bill as appropriate.                                                                                            
                                                                                                                                
MR. PEARCE,  in response to  a question, explained that  the DHSS                                                               
registers  radiologic   equipment  and  he  then   inspects  that                                                               
equipment.   He  noted  that some  facilities  in Alaska  operate                                                               
under the purview of the  federal government and so the radiology                                                               
equipment  at   those  facilities  is  inspected   by  a  federal                                                               
inspector,  though  he  also   conducts  federal  inspections  of                                                               
certain equipment through a program administered by the DHSS.                                                                   
                                                                                                                                
REPRESENTATIVE  ANDERSON surmised,  then, that  currently no  one                                                               
monitors the operation of radiology equipment.                                                                                  
                                                                                                                                
MR. PEARCE concurred.                                                                                                           
                                                                                                                                
REPRESENTATIVE ANDERSON  asked how many states  currently license                                                               
radiologic technicians.                                                                                                         
                                                                                                                                
MR. PEARCE said  39 according to his understanding.   In response                                                               
to another question, he acknowledged  that such licensure appears                                                               
to be the trend.                                                                                                                
                                                                                                                                
REPRESENTATIVE  GARA indicated  that  he is  no longer  concerned                                                               
that the training  requirements of the bill are  too onerous, but                                                               
said he  is not  thrilled with a  complete exemption  for certain                                                               
groups of people.                                                                                                               
                                                                                                                                
MR. PEARCE,  on that first  point, acknowledged that there  are a                                                               
number of  online sources  for training and  thus people  will be                                                               
able to obtain the required  training without having to leave the                                                               
community.                                                                                                                      
                                                                                                                                
3:53:20 PM                                                                                                                    
                                                                                                                                
BARBARA  HUFF TUCKNESS,  Director,  Governmental and  Legislative                                                               
Affairs,  Teamsters  Local  959, relayed  that  her  organization                                                               
supports  the   original  version  of   HB  150,  and   that  her                                                               
organization is  fortunate to represent radiologists  in hospital                                                               
facilities   who   are   already  under   collective   bargaining                                                               
agreements to be  certified.  She said  her organization supports                                                               
certification, and  noted that nurses'  aides are required  to be                                                               
certified as nurses'  aides in both urban and  rural settings; in                                                               
other  words,  there  is  no  exemption  from  certification  for                                                               
nurses' aides in rural settings.   Notwithstanding support of the                                                               
original bill,  her organization  is willing  to accept  the fact                                                               
that adoption  of the  proposed CS  will be a  step in  the right                                                               
direction.   She concluded by  asking that  HB 150 be  moved from                                                               
committee.                                                                                                                      
                                                                                                                                
3:55:16 PM                                                                                                                    
                                                                                                                                
CHAIR McGUIRE  referred to Amendment  1, which,  with handwritten                                                               
corrections   and  some   formatting   changes,  read   [original                                                               
punctuation provided]:                                                                                                          
                                                                                                                                
     Insert at p.2 line 21                                                                                                      
                                                                                                                                
          (d) "under the supervision" and "under the direct                                                                     
     supervision" in this subsection  shall include, but not                                                                    
     be  limited to,  under supervision  needed to  ensure a                                                                    
     radiological  examination   is  performed   safely  and                                                                    
     appropriately.                                                                                                             
                                                                                                                                
CHAIR McGUIRE  [although no  formal motion  to adopt  Amendment 1                                                               
had been made] objected for the purpose of discussion.                                                                          
                                                                                                                                
REPRESENTATIVE  GARA,  speaking as  the  author  of Amendment  1,                                                               
indicated  that Amendment  1 would  provide  some guidelines  for                                                               
those exempted from the training requirements of the bill.                                                                      
                                                                                                                                
3:56:51 PM                                                                                                                    
                                                                                                                                
DONNA M. ELLIOT, Alaska Native  Tribal Health Consortium (ANTHC),                                                               
said she  would be speaking in  opposition to HB 150  for reasons                                                               
similar to those expressed by Mr.  Hall and Mr. Devlin.  She said                                                               
the ANTHC believes  that the bill is poorly  written and contains                                                               
room for  changes so  as not  to place  an unnecessary  burden on                                                               
existing  radiological technicians  who  are employed  throughout                                                               
the  Alaska tribal  health system.   It's  already a  complex and                                                               
costly network of  delivery of care, and  additional criteria for                                                               
technicians would  require a lot  of time  and money.   The ANTHC                                                               
trusts  that  staff  are  capable   of  training  and  overseeing                                                               
necessary training  so that imagery  services are  performed with                                                               
competence, and  feels that [HB  150] does  not fit the  scope of                                                               
providing care in the rural healthcare model, she concluded.                                                                    
                                                                                                                                
3:58:09 PM                                                                                                                    
                                                                                                                                
DON  SMITH,   P.A.,  President,   Alaska  Academy   of  Physician                                                               
Assistants (AKAPA),  after relaying  that he co-owns  two medical                                                               
clinics, said  that he agrees with  Mr. Hall's comments.   If the                                                               
bill is really  intended to address a safety  issue, he remarked,                                                               
then  he  is  not  sure  how  exempting  "licensed  practitioner"                                                               
furthers that  goal.  Just  because one has advanced  training in                                                               
the field  of medicine doesn't  mean that he/she is  competent in                                                               
the operation  of radiologic equipment.   He asked that  the bill                                                               
be  changed  to  separate  out  "in-office"  or  "in-clinic"  and                                                               
especially  "rural   clinic"  x-rays  from  the   requirement  of                                                               
licensure.  "I highly agree  that persons taking nuclear medicine                                                               
studies,  CT   scans,  high  radiation  studies   ...  should  be                                                               
regulated and  licensed, but I  do not  see the safety  issue nor                                                               
has anybody offered  any safety data that  in-office in-clinic x-                                                               
rays are a huge harm to the public," he concluded.                                                                              
                                                                                                                                
CHAIR  McGUIRE  asked  whether   Mr.  Smith  is  suggesting  that                                                               
licensed practitioners, and licensed  PAs, should not be exempted                                                               
from the bill's licensure requirement.                                                                                          
                                                                                                                                
MR.  SMITH said  he is  simply suggesting  that the  committee be                                                               
careful  with the  concept of  exempting "licensed  practitioner"                                                               
because such a person may not be competent to take x-rays.                                                                      
                                                                                                                                
REPRESENTATIVE ANDERSON  remarked that  PAs were exempted  at the                                                               
request of the AKAPA.                                                                                                           
                                                                                                                                
CHAIR  McGUIRE   said  the  committee  would   consider  removing                                                               
"licensed  practitioner" from  the  list of  those  who would  be                                                               
exempt from the licensure requirements of the bill.                                                                             
                                                                                                                                
4:00:59 PM                                                                                                                    
                                                                                                                                
MARK  RESTAD, P.A.,  Clinical Administrator,  Ninilchik Community                                                               
Clinic,  noted  that  he  has  practiced  in  Tok,  Healy,  Delta                                                               
[Junction],  Ninilchik,  Fairbanks,  Kotzebue,  and  Kenai.    He                                                               
opined  that   there  should  be  a   distinction  between  basic                                                               
radiography  and advanced  radiologic  studies, mammography,  and                                                               
advanced nuclear studies.  He  said that from his perspective, he                                                               
is concerned about access to  care, unneeded medevacs, not having                                                               
access  to emergency  medevacs  for those  that  really need  it,                                                               
putting [fishing] crews at risk  of needing medevacs for shoulder                                                               
dislocations - because such cannot  be treated without a basic x-                                                               
ray - and an  inability to have a person on site  when there is a                                                               
small staff serving a large geographic region.                                                                                  
                                                                                                                                
MR. RESTAD  opined that "a  dichotomy of basic  radiology studies                                                               
needs to  be done."   He  noted that his  clinic currently  has a                                                               
physicist [funded] through  the federal system that  does look at                                                               
exposure rates  in the clinic  to ensure  that they are  within a                                                               
safe range; the  clinic's equipment is registered  and the clinic                                                               
has used  due diligence to ensure  the safety of the  public.  In                                                               
conclusion he asked that the  proposed fines be reviewed with the                                                               
perspective  of ensuring  access  to healthcare  services by  all                                                               
Alaskans.                                                                                                                       
                                                                                                                                
4:03:13 PM                                                                                                                    
                                                                                                                                
MARILYN   KASMAR,  Executive   Director,   Alaska  Primary   Care                                                               
Association, Inc.  (APCA), relayed  that the APCA  represents 150                                                               
community  health  centers  in   Alaska  and  other  "safety  net                                                               
providers," and  that health  centers are  private not-for-profit                                                               
clinics  that operate  on very  slim margins,  typically, and  of                                                               
which the  great majority are  in remote  and rural areas  of the                                                               
state.   She  said  that the  APCA appreciates  that  HB 150  now                                                               
contains the  alternative of demonstrated  experience in  lieu of                                                               
graduating from  a program,  and pointed out  that there  has not                                                               
yet  been  an   adverse  case  or  lawsuit   attributed  to  poor                                                               
radiography practices in community health centers.                                                                              
                                                                                                                                
MS. KASMAR said that health centers  have always had to answer to                                                               
federal  program expectations,  which helps  to ensure  that they                                                               
consistently practice safe  radiography.  She said  that the APCA                                                               
agrees with the comments of Mr.  Devlin, Mr. Hall, and Ms. Elliot                                                               
with regard  to the potential  hardship and negative  impacts the                                                               
bill could  cause.  She requested  that "bullets" 3 and  4 of the                                                               
letter provided by the APCA  be considered as possible changes to                                                               
HB 150:                                                                                                                         
                                                                                                                                
     Extensions   to  temporary   permits   be  granted   to                                                                    
     [community health  center] CHC staff when  necessary so                                                                    
     that sites will not be  forced to transport patients to                                                                    
     larger  cities  for   radiography  services;  Temporary                                                                    
     permits be  granted to CHC  staff that do not  have two                                                                    
     years  of   prior  experience  if  the   lack  of  said                                                                    
     temporary permit  would translate  into CHCs  having to                                                                    
     transport patients into larger cities                                                                                      
                                                                                                                                
MS. KASMAR noted  that there would be an increased  cost to state                                                               
Medicaid if  people have to  be transported out  for radiological                                                               
services.                                                                                                                       
                                                                                                                                
4:05:51 PM                                                                                                                    
                                                                                                                                
MS. RUFSHOLM, adding to her previous testimony, said:                                                                           
                                                                                                                                
     As a radiologic technologist,  I know that radiation is                                                                    
     a carcinogen  and that the  operators of  medical x-ray                                                                    
     equipment  deliver  the   largest  portion  of  manmade                                                                    
     radiation  to  the  general   public.    (Indisc.)  the                                                                    
     average patient  doesn't know  this; they  aren't aware                                                                    
     of  the facts,  and they  just have  confidence in  the                                                                    
     fact that  the healthcare  worker who's  performing the                                                                    
     procedure  knows what  they're doing.   Passage  of [HB
     150]  will  establish  the  standards  for  individuals                                                                    
     performing x-ray  exams, standards that don't  exist in                                                                    
     some clinical sites as shown  by the examples of misuse                                                                    
     of  radiation,  documented  by  the  State  of  Alaska,                                                                    
     [office] of Radiological Health.                                                                                           
                                                                                                                                
     There's  a copy  of  this list  included in  [committee                                                                    
     packets] ...; it's quite an  extensive list and it does                                                                    
     show that  there are incidents happening  in the state,                                                                    
     today, where  the operators of  x-ray equipment  do not                                                                    
     know  what  they  are  doing.     We  can't  blame  the                                                                    
     operators -  they're uneducated -  we can't  blame them                                                                    
     for  the errors  that  they've made;  they've not  been                                                                    
     required to get the education  that they need to do the                                                                    
     job   correctly,  nor   have   they   been  given   the                                                                    
     opportunity.                                                                                                               
                                                                                                                                
     Opponents  of [HB  150] state  that it  is a  financial                                                                    
     burden,  [but] $229,  the cost  for  one individual  to                                                                    
     take  an extensive  online  limited  scope program,  is                                                                    
     equal to the reimbursement for  one x-ray procedure - a                                                                    
     small  amount to  pay to  [ensure] ...  patient safety.                                                                    
     House  Bill 150  will  not change  the  way that  small                                                                    
     businesses and  rural clinics  operate.   The committee                                                                    
     recognizes the fact  that the rural areas  of the state                                                                    
     have different  needs than the  urban areas,  and we've                                                                    
     worked with  groups around the  state to  address those                                                                    
     needs.  We  understand the importance of  being able to                                                                    
     provide   radiology   services    for   patient   care,                                                                    
     especially in the rural areas.                                                                                             
                                                                                                                                
MS. RUFSHOLM continued:                                                                                                         
                                                                                                                                
     We've made  provisions in the  bill to ensure  that the                                                                    
     individuals who  currently perform x-ray  procedures at                                                                    
     those  sites  will  (indisc. -  coughing)  do  so,  the                                                                    
     clinics  will have  no interruption  in services  while                                                                    
     their  staff receives  training, [and]  there'll be  no                                                                    
     loss of services  in the rural areas or  a reduction in                                                                    
     patient access  to quality and complete  point of care.                                                                    
     Given  that  requiring  operators  to  be  trained  and                                                                    
     tested  does  not  increase costs,  does  not  restrict                                                                    
     access   (indisc.  -   coughing),  will   not  increase                                                                    
     salaries,  will not  force clinics  to close,  will not                                                                    
     cause  staffing shortages,  will not  create burdensome                                                                    
     financial   obligations  to   facilities,  and   [that]                                                                    
     training  can   be  completed  at  a   place  and  time                                                                    
     convenient to the operators, there  should be no reason                                                                    
     for  any of  us  not  to be  the  patient advocate  and                                                                    
     establish   standards  ...   for  persons   (indisc.  -                                                                    
     coughing) radiology  procedures.  Thank you  for giving                                                                    
     me the opportunity to testify.                                                                                             
                                                                                                                                
4:08:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ANDERSON  asked what would be  required of someone                                                               
who has already been operating radiological equipment.                                                                          
                                                                                                                                
MS. RUFSHOLM said that such a  person would have two options.  If                                                               
he/she  has  the  basic  concept  of  radiology  positioning  and                                                               
radiation,  and patient  and operator  safety, and  can pass  the                                                               
aforementioned proposed exam,  then he/she will be able  to get a                                                               
limited radiological  imager license.   If  he/she is  either not                                                               
able to pass  the exam or doesn't have  enough experience, he/she                                                               
can enroll  in one  of the  courses available  - one  through the                                                               
University  of Alaska  Anchorage (UAA)  or another  online course                                                               
that has been identified as  being available to anyone at anytime                                                               
and that  consists of approximately  240 online hours -  pass the                                                               
exam for  that program, get  a certificate, and then  be eligible                                                               
for  a limited  scope license.   She  reiterated that  the course                                                               
programs cost $229.                                                                                                             
                                                                                                                                
REPRESENTATIVE WILSON asked what would  happen in "hard to serve"                                                               
areas when a clinic must fill  an open position.  She then opined                                                               
that the bill will make it harder to fill such positions.                                                                       
                                                                                                                                
MS. RUFSHOLM  noted that most  people employed in  clinics aren't                                                               
just  performing  x-ray procedures,  and  so  anyone newly  hired                                                               
would be  performing those other  tasks and would be  expected to                                                               
immediately  enroll  in the  required  program,  get a  temporary                                                               
permit, and  also start performing x-ray  procedures; patients in                                                               
those areas  would not be  denied radiology services in  any way.                                                               
Perhaps  that  is   not  the  best  way  to  go   about  it,  she                                                               
acknowledged,  but it  is not  the intent  of the  legislation to                                                               
impact care  in rural  areas; there  is simply  still a  need for                                                               
education.    She  suggested  that   adoption  of  the  standards                                                               
proposed in  HB 150 will create  a new career path  for people in                                                               
rural areas and is thus providing  them with an incentive to stay                                                               
in the village.                                                                                                                 
                                                                                                                                
CHAIR McGUIRE surmised, then, that as  long as one is enrolled in                                                               
an approved course, then one can begin taking x-rays.                                                                           
                                                                                                                                
MS.  RUFSHOLM concurred  with  that  summation, reiterating  that                                                               
although that  is not  the ideal,  it will  allow those  in rural                                                               
areas  to  continue  to provide  radiologic  services;  currently                                                               
people   are  performing   radiologic   procedures  without   any                                                               
education.   House  Bill 150  will ensure  that such  people will                                                               
have the education needed to  perform radiologic procedures while                                                               
also  protecting  both themselves  and  the  patient -  radiation                                                               
safety for both the patient and  the operator is one of the first                                                               
components of the aforementioned course.                                                                                        
                                                                                                                                
MS. RUFSHOLM, in response to  a question, clarified that before a                                                               
person  could  start  performing  radiologic  procedures,  he/she                                                               
would  have to  have  temporary license  which  in turn  requires                                                               
proof that  he/she is enrolled in  a program and begun  it - that                                                               
temporary license would then be good for a year.                                                                                
                                                                                                                                
4:15:45 PM                                                                                                                    
                                                                                                                                
KEN G. TRUITT, General Counsel,  Southeast Alaska Regional Health                                                               
Consortium  (SEARHC),  said  he's  came  to  offer  testimony  in                                                               
opposition to the "existing" version  of HB 150, and relayed that                                                               
SEARHC  appreciates the  recognition of  work experience  towards                                                               
meeting the qualification requirements.  He went on to say:                                                                     
                                                                                                                                
     We  share the  concerns that  this is  really going  to                                                                    
     reduce  access to  care.   And  so if  ... patient  ...                                                                    
     health and  safety [is what's]  ... driving  this, this                                                                    
     bill ... -  in the adopted version that  you had before                                                                    
     the work draft - would  reduce access to care and would                                                                    
     reduce  patient safety  instead, and  so we  agree with                                                                    
     the other  rural providers that testified  on that. ...                                                                    
     In  a  previous life  I  would  have  been one  of  the                                                                    
     assistant attorney generals  advising the medical board                                                                    
     ... [and] the division  that would be implementing this                                                                    
     law.                                                                                                                       
                                                                                                                                
     In general,  there was a  passing reference  earlier in                                                                    
     the hearing to, "There's  always going to be opposition                                                                    
     to  this," and  I think  that it's  hard ...  for folks                                                                    
     that  are  opposing [the  bill]  ...  when that's  made                                                                    
     light of, because you've got  two very strong competing                                                                    
     interests, here,  whenever you talk about  regulating a                                                                    
     profession - specifically,  the constitutional right to                                                                    
     liberty.  You're impacting  somebody's liberty by doing                                                                    
     this; you're  taking a profession that  before this has                                                                    
     not had  regulation or state oversight  ..., and you're                                                                    
     taking that  liberty away.   That's  juxtaposed against                                                                    
     the reserved power for the  states, under police power,                                                                    
     to  watch out  and  safeguard the  public  health.   So                                                                    
     those are  [two very]  strong competing  interests, and                                                                    
     it  is difficult  to hear  ...  the opposing  interests                                                                    
     made light of. ...                                                                                                         
                                                                                                                                
     Professor  Freidman (ph),  in his  seminal work  on the                                                                    
     history  of American  law, ...  when he  chronicles the                                                                    
     history   of   the   regulation  of   professions,   he                                                                    
     characterizes it,  and its whole treatment  of it, [as]                                                                    
     a  holdover from  the guild  era, from  the guild  age,                                                                    
     where the  primary responsibility of the  guilds was to                                                                    
     protect the economic interests of  those members of the                                                                    
     profession, and those members of  the profession have a                                                                    
     very vested  interest in reducing the  number of people                                                                    
     in their  profession, to keep their  services in demand                                                                    
     and the  prices for those  services high.  And  what we                                                                    
     have here on  the legislative record is  that this bill                                                                    
     has  been drafted  by the  members  of this  profession                                                                    
     that want to be regulated. ...                                                                                             
                                                                                                                                
     Again,  it's  hard to  hear  that  made light  of,  the                                                                    
     opposition  to that,  when it  looks like  this is  the                                                                    
     "guild"  trying  to  "circle the  wagons,"  reduce  the                                                                    
     number of providers that are  competent and licensed to                                                                    
     perform this  service, thereby driving up  the costs of                                                                    
     those  services  and  reducing   the  access  to  those                                                                    
     services.   And  that  is our  fear,  in general,  with                                                                    
     this, ...  [though] we appreciate  the work draft  - we                                                                    
     think that goes a long  way towards helping those of us                                                                    
     who  are going  to be  subject to  it find  alternative                                                                    
     ways to  meet those regulations  - and we  look forward                                                                    
     to continuing to work on that.                                                                                             
                                                                                                                                
4:19:32 PM                                                                                                                    
                                                                                                                                
CHAIR  McGUIRE said  her  motivation is  public  safety, and  she                                                               
views  the  issue as  being  one  of  public health  rather  than                                                               
economics  [for industry  members].   She said  she is  satisfied                                                               
that the sponsor  has worked to a reasonable point  to reduce the                                                               
barriers  to obtaining  training  and licensure.   She  indicated                                                               
that it is not her intent to raise healthcare costs.                                                                            
                                                                                                                                
MR. TRUITT, on  the issue of "licensed  practitioners", said that                                                               
perhaps  [someone from  the Department  of Law]  should speak  to                                                               
that issue,  particularly with  regard to  the definition  of the                                                               
practice  of medicine  as that  term applies  to portions  of the                                                               
bill.   "By removing 'licensed  practitioner' from this  bill you                                                               
might  have to  ... then  say  that this  particular activity  is                                                               
exempted  from the  definition of  the practice  of medicine  not                                                               
regulated by  the medical  board," he  added.   He said  that the                                                               
SEARHC  would support  keeping  "licensed  practitioner" in,  but                                                               
then the committee must face  the conundrum that some doctors may                                                               
not even  know how to turn  on the radiologic equipment  in their                                                               
office.                                                                                                                         
                                                                                                                                
REPRESENTATIVE GARA  said he  wants to  ensure that  the proposed                                                               
standards are  achievable and  that rural  and small  clinics are                                                               
able to provide needed services on the budgets they have.                                                                       
                                                                                                                                
REPRESENTATIVE  GRUENBERG  asked  Representative  Wilson  whether                                                               
nurses are trained to use radiologic equipment.                                                                                 
                                                                                                                                
[Representative Wilson shook her head.]                                                                                         
                                                                                                                                
REPRESENTATIVE GRUENBERG  remarked, "So it's assumed  that you'll                                                               
have somebody else do them?"                                                                                                    
                                                                                                                                
REPRESENTATIVE WILSON  replied, "Or else  that if you go  to work                                                               
in a  clinic ..., there's someone  there that will train  you and                                                               
show you what to do ...."                                                                                                       
                                                                                                                                
CHAIR McGUIRE remarked, "Boy, that's scary."                                                                                    
                                                                                                                                
MR. TRUITT offered to continue  working [with the sponsor] on the                                                               
issue of experience requirements.                                                                                               
                                                                                                                                
4:25:18 PM                                                                                                                    
                                                                                                                                
MICHAEL  FORD,   Alaska  Native  Health  Board   (ANHB),  relayed                                                               
information about the  ANHB, and noted that he has  seen a lot of                                                               
bills  similar to  HB 150.    He relayed  that the  ANHB is  very                                                               
committed  to providing  the best  and safest  medical assistance                                                               
possible, but does have serious concerns  with a bill like HB 150                                                               
in terms  of cost, particularly in  rural areas.  He  offered his                                                               
opinion that the  fact that the costs and  benefits of regulating                                                               
this industry are hard to identify  is one of the primary reasons                                                               
for  this legislation  not  having  become law  for  the last  10                                                               
years.   He  added that  he  appreciates the  sponsor's work  and                                                               
would be  willing to assist him  in coming up with  language that                                                               
would alleviate the ANHB's concerns.                                                                                            
                                                                                                                                
MR. FORD  then referred to the  penalty provisions of HB  150 and                                                               
noted  that it  will  be  a class  A  misdemeanor for  unlicensed                                                               
practice,  whereas  it   will  be  a  class   B  misdemeanor  for                                                               
fraudulent practice.   He  suggested that one  who uses  fraud to                                                               
obtain a  license should receive  a harsher penalty than  one who                                                               
simply practices  without a license.   He then  characterized the                                                               
exemption provisions  of HB 150  as critical, adding,  "You have,                                                               
in a  sense, excluded certain  areas of practice."   For example,                                                               
under  Version R,  dentists won't  have to  change their  current                                                               
practice; a  prior version  required dentists to  be in  the same                                                               
room with the person performing the  x-ray procedure.  He said he                                                               
doesn't necessarily  know why  performing x-ray  procedures under                                                               
the supervision  of a licensed  practitioner should  be exempted,                                                               
particularly  given  that it  does  not  necessarily follow  that                                                               
licensed  practitioners  have  experience  in  the  operation  of                                                               
radiological equipment.                                                                                                         
                                                                                                                                
MR. FORD  said he would  like to put  together a work  group that                                                               
would formulate language addressing everyone's concerns.                                                                        
                                                                                                                                
REPRESENTATIVE  ANDERSON  noted that  the  bill  still has  other                                                               
committee referrals.                                                                                                            
                                                                                                                                
4:31:27 PM                                                                                                                    
                                                                                                                                
RICHARD MANDSAGER,  M.D., Director,  Central Office,  Division of                                                               
Public Health,  Department of Health and  Social Services (DHSS),                                                               
commented that  access and safety  are both important  issues and                                                               
therefore a  balance between the two  must be found, and  that he                                                               
is encouraged by  Version R.  He  noted that at one  of his jobs,                                                               
all  of  the doctors  got  on-the-spot  training  in how  to  use                                                               
radiological  equipment, and  he  thinks that  they all  probably                                                               
performed x-rays  safely, but what was  safe 25 years ago  may no                                                               
longer   be  considered   safe,   particularly  considering   the                                                               
cumulative effects of radiation exposure.                                                                                       
                                                                                                                                
DR. MANDSAGER, in response to  comments, noted that dental x-rays                                                               
expose a  person to only a  fraction of the radiation  that other                                                               
types of x-ray procedures expose a  person to, and that those who                                                               
perform CT  scans, for example, receive  a lot of training.   The                                                               
argument,  he  surmised,  is  all  about  how  much  training  is                                                               
necessary for what  type of radiologic procedures.   "I think the                                                               
safety argument is  still really important, and as  we get online                                                               
training and so  on available to improve the  safety but maintain                                                               
access, we can  strike a balance point that will  be good for the                                                               
state," he remarked.                                                                                                            
                                                                                                                                
CHAIR McGUIRE asked Dr. Mandsager  whether the Division of Public                                                               
Health could  play an instrumental  role with regard  to outreach                                                               
and assembling online courses.                                                                                                  
                                                                                                                                
DR. MANDSAGER indicated  that that issue is one that  ought to be                                                               
considered  by  the  division,  and noted  that  with  regard  to                                                               
licensure  of  radiological  technicians,   the  state  is  on  a                                                               
journey.   He concluded  by remarking that  the penalties  in the                                                               
bill seem fairly high.                                                                                                          
                                                                                                                                
LINDA  FINK, Vice  President, Alaska  State Hospital  and Nursing                                                               
Home  Association   (ASHNHA),  stated  simply  that   the  ASHNHA                                                               
supports HB 150.                                                                                                                
                                                                                                                                
4:36:43 PM                                                                                                                    
                                                                                                                                
LAURIE HERMAN, Regional  Director, Government Affairs, Providence                                                               
Health  System-Alaska;  Member,   Legislative  Committee,  Alaska                                                               
State  Hospital and  Nursing  Home  Association (ASHNHA),  stated                                                               
that both  Providence Health  System-Alaska and  ASHNHA continues                                                               
to support HB 150.                                                                                                              
                                                                                                                                
MS.  HERMAN, in  response to  a question,  said she  doesn't know                                                               
whether   licensed  nurse   practitioners  receive   training  in                                                               
performing radiological procedures as a matter of course.                                                                       
                                                                                                                                
REPRESENTATIVE  GARA said  he is  concerned that  the bill  would                                                               
exempt certain people, such as  licensed practitioners, even when                                                               
they don't have sufficient training.                                                                                            
                                                                                                                                
REPRESENTATIVE ANDERSON  noted that  the definition  of "licensed                                                               
practitioner" can  be found on  page 10,  lines 26-19; HB  150 is                                                               
proposing to exempt licensed practitioners  from the training and                                                               
licensing requirements contained therein.                                                                                       
                                                                                                                                
4:40:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WILSON   cautioned  against   requiring  licensed                                                               
practitioners  to   have  training  in   performing  radiological                                                               
procedures because it could negatively impact access to care.                                                                   
                                                                                                                                
REPRESENTATIVE   GRUENBERG,   referring    to   a   letter   from                                                               
B.J. Anderson, Radiology  Manager, Anchorage  Neighborhood Health                                                               
Center (ANHC), he read:                                                                                                         
                                                                                                                                
     Dear House Judiciary Committee,  I am writing in regard                                                                    
     to  HB   150,  which   relates  to  the   licensing  of                                                                    
     radiologic technicians  in the  state of Alaska.   This                                                                    
     bill continues to  be flawed in that it  does not allow                                                                    
     organizations to begin  training radiologic technicians                                                                    
     on the  job at the time  of hire.  This  flexibility is                                                                    
     absolutely necessary  for:  one, Alaska  health centers                                                                    
     who cross-train  personnel for several job  tasks; and,                                                                    
     two, Alaska health centers that  have to draw personnel                                                                    
     from  their  communities because  there  is  a lack  of                                                                    
     certified  personnel available  or willing  to live  in                                                                    
     rural Alaska.                                                                                                              
                                                                                                                                
     I would  propose that the  limited temporary  permit be                                                                    
     written to  include on-the-job training that  can begin                                                                    
     immediately  upon hire  with the  stipulation that  the                                                                    
     person  must  be  enrolled in  an  approved  radiologic                                                                    
     training program  as soon as  possible.   The temporary                                                                    
     [permit] ... could be written  to give organizations up                                                                    
     to six  months ...  - or  whatever the  committee deems                                                                    
     reasonable  - ...  to enroll  employees in  an approved                                                                    
     program.                                                                                                                   
                                                                                                                                
     ...  It   is  imperative   that  the  bill   allow  the                                                                    
     flexibility,    and    recognize    the    value    and                                                                    
     reasonableness, of on-the-job training. ...                                                                                
                                                                                                                                
4:44:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GRUENBERG asked Ms.  Rufsholm whether she would be                                                               
amenable  to   a  conceptual  amendment  that   would  allow  the                                                               
department to  issue a nonrenewable  temporary permit,  valid for                                                               
up to 90 days for an  employee of a nonprofit neighborhood health                                                               
center,  to  an  applicant  who  pays a  fee  determined  by  the                                                               
department  if  the applicant  enrolls  in  an approved  training                                                               
program as a  radiological technician within that  period of time                                                               
and is training  on the job under a person  licensed or permitted                                                               
under [proposed] AS 08.89.110(a)(a).                                                                                            
                                                                                                                                
MS. RUFSHOLM pointed  out that the language on page  5 [lines 18-                                                               
24]  of Version  R already  provides  for such  a limited  permit                                                               
though it would be  valid for up to one year  rather than just 90                                                               
days  as Representative  Gruenberg is  proposing; furthermore,  a                                                               
person  can enroll  immediately  into  the aforementioned  online                                                               
course and  begin that course  without going through  any waiting                                                               
period.   She relayed  that Mr.  Pearce knows  of an  instance in                                                               
which a person was given 64  times the amount of radiation needed                                                               
because  the   person  doing  the  procedure   had  been  trained                                                               
incorrectly on the job; not  all on-the-job training is the same,                                                               
and  this  example  illustrates  a  real  need  for  standardized                                                               
training.   It  will not  be  a burden  to enroll  in a  training                                                               
program  and  at  least  start it  before  doing  any  radiologic                                                               
procedures,  she opined;  furthermore,  not  all facilities  have                                                               
registered technologists that could  supervise a trainee as would                                                               
be  required under  Representative Gruenberg's  suggested change,                                                               
and although  she knows that  the standards  set by the  ANHC for                                                               
performing radiologic  procedures are very high,  those standards                                                               
are not being followed statewide.                                                                                               
                                                                                                                                
REPRESENTATIVE  ANDERSON relayed  that he  has already  discussed                                                               
this issue with  the executive director of the  ANHC, and offered                                                               
to discuss it further.                                                                                                          
                                                                                                                                
REPRESENTATIVE WILSON  said she doesn't  know why they  would not                                                               
want Representative  Gruenberg's suggested  change to  also apply                                                               
to for-profit clinics.                                                                                                          
                                                                                                                                
4:49:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GRUENBERG indicated  a willingness  to work  with                                                               
the sponsor on the issues raised.                                                                                               
                                                                                                                                
REPRESENTATIVE   GARA  withdrew   Amendment   1  [text   provided                                                               
previously].                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARA  made a motion  to adopt Amendment  2, which,                                                               
with   handwritten   corrections,  read   [original   punctuation                                                               
provided]:                                                                                                                      
                                                                                                                                
     Insert at p.2 line 21                                                                                                      
                                                                                                                                
          "(d) In this subsection "under the supervision"                                                                       
     and "under  the direct supervision" in  this subsection                                                                    
     shall   include,  but   not   be   limited  to,   under                                                                    
     supervision  needed to  ensure  an exam  or test  under                                                                    
     this section is performed safely and appropriately.                                                                        
                                                                                                                                
     (e)  a  licensed  practitioner   shall  be  allowed  to                                                                    
     perform  an   exam  or  test  under   this  section  if                                                                    
     otherwise performed in compliance  with law, and if the                                                                    
     practitioner  has  obtained  education or  training  to                                                                    
     ensure  the   exam  or  test  is   performed  safely  &                                                                    
     appropriately."                                                                                                            
                                                                                                                                
REPRESENTATIVE GARA  explained that Amendment 2  would insert new                                                               
subsections (d)  and (e)  into proposed  AS 08.89.100,  and would                                                               
say that  if one is exempted  from any of the  bill's training or                                                               
testing requirements, then one must  either be trained to or have                                                               
the  knowledge  to,  or be  supervised  by  someone  specifically                                                               
trained to  or have the  knowledge to, ensure that  the procedure                                                               
is performed safely and appropriately.                                                                                          
                                                                                                                                
4:51:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ANDERSON  indicated that  he has no  objections to                                                               
Amendment 2.                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WILSON  objected,   and  expressed  concern  that                                                               
Amendment  2  will negatively  impact  rural  areas, adding  that                                                               
she's not heard from anyone that  there is a problem.  She opined                                                               
that those  who are currently performing  radiological procedures                                                               
in rural  areas have received sufficient  on-the-job training and                                                               
don't need certification or licensure.                                                                                          
                                                                                                                                
CHAIR  McGUIRE offered  her understanding  that Amendment  2 will                                                               
make allowances for just that  sort of on-the-job training.  "The                                                               
concern  is that  if  you just  simply say  ...,  'Well you're  a                                                               
licensed  practitioner,  therefore  you can  perform  it',  we're                                                               
really kind of  going against the grain of the  bill, which is to                                                               
say, 'We want  you to have some training ...  in this area'," she                                                               
added.    Under  [Amendment  2],  she  posited,  the  folks  that                                                               
Representative Wilson is referring to would qualify.                                                                            
                                                                                                                                
REPRESENTATIVE ANDERSON  reiterated his  support of  Amendment 2,                                                               
but  expressed discomfort  with the  concept of  allowing someone                                                               
who had  a little  bit of  training 25 years  ago to  qualify for                                                               
performing or supervising the performance of radiological exams.                                                                
                                                                                                                                
REPRESENTATIVE  WILSON reiterated  that  she  is concerned  about                                                               
rural areas.                                                                                                                    
                                                                                                                                
CHAIR McGUIRE  noted that times  are changing and people  have to                                                               
realize  that  radiation  is  a carcinogenic.    Those  that  are                                                               
performing  radiologic   exams  currently  and  those   who  have                                                               
obtained some kind  of training will be allowed  to continue, but                                                               
those  that aren't  currently performing  such  exams or  haven't                                                               
received  some  form  of  training   will  have  to  fulfill  the                                                               
educational  requirements of  the  bill.   She acknowledged  that                                                               
perhaps some  clinics operating in  rural areas will come  to the                                                               
state and ask for the money  to cover the costs of that training.                                                               
Radiation is serious stuff, she  remarked, and suggested that the                                                               
reason Representative Wilson hasn't seen  any evidence of harm is                                                               
that  the   effects  of  over-radiation  cannot   often  be  seen                                                               
immediately.                                                                                                                    
                                                                                                                                
REPRESENTATIVE WILSON  said she  doesn't know what  the long-term                                                               
ramifications  of Amendment  2 will  be, again  expressed concern                                                               
that access to  care in rural areas will  decrease, and suggested                                                               
that simple x-rays are not harmful.                                                                                             
                                                                                                                                
CHAIR  McGUIRE noted  that the  proposed temporary  licenses last                                                               
one year,  and so a  future legislature could address  any issues                                                               
that arise as a result  of the proposed educational and licensure                                                               
requirements.                                                                                                                   
                                                                                                                                
4:58:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE ANDERSON called the question.                                                                                    
                                                                                                                                
CHAIR  McGUIRE instead  offered  members  another opportunity  to                                                               
speak.                                                                                                                          
                                                                                                                                
REPRESENTATIVE  GARA  noted  that  Amendment 2  pertains  to  the                                                               
exemption provisions of the bill,  and suggested that without it,                                                               
licensed  practitioners will  be  allowed  to perform  radiologic                                                               
procedures even if they don't know how to do them safely.                                                                       
                                                                                                                                
REPRESENTATIVE WILSON argued  that this will result in  a cost to                                                               
rural clinics.                                                                                                                  
                                                                                                                                
REPRESENTATIVE GARA countered that  under Amendment 2, only those                                                               
licensed practitioners that have  had no training whatsoever will                                                               
be precluded from performing radiologic exams.                                                                                  
                                                                                                                                
REPRESENTATIVE  WILSON opined  that  licensed practitioners  have                                                               
never  had any  such  training; furthermore,  they don't  perform                                                               
radiologic exams.                                                                                                               
                                                                                                                                
REPRESENTATIVE  GARA pointed  out, then,  that Amendment  2 won't                                                               
change  current  practice  and   therefore  it  won't  result  in                                                               
increased  costs; Amendment  2  only applies  to  those that  are                                                               
performing radiologic exams.                                                                                                    
                                                                                                                                
REPRESENTATIVE  KOTT   noted  that  dental  assistants   are  not                                                               
included in the definition of "licensed practitioner".                                                                          
                                                                                                                                
MR. HILYARD  pointed out,  though, that via  language on  page 2,                                                               
lines 6-7, of Version R,  dental assistants under the supervision                                                               
of licensed  practitioners are being exempted  from the licensure                                                               
provisions of the bill.                                                                                                         
                                                                                                                                
5:01:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GRUENBERG  pondered  whether  language  could  be                                                               
added to the bill that would provide for educational grants.                                                                    
                                                                                                                                
REPRESENTATIVE ANDERSON  agreed to consider the  addition of such                                                               
language as the bill continues through the process.                                                                             
                                                                                                                                
MR.  HILYARD  pointed out  that  [proposed  AS 08.89.100]  has  a                                                               
delayed effective  date of two  years.   On the issue  of whether                                                               
radiological procedures have been  demonstrated to be harmful, he                                                               
relayed  that  members'  packets  include  an  article  from  the                                                               
University of California,  Berkeley, that says a  noted expert on                                                               
the  health  effects of  radiation  has  concluded that  a  large                                                               
proportion of deaths today from  cancer and heart disease are due                                                               
in part  to past exposure to  medical radiation.  The  expert was                                                               
quoted  in  that article  as  saying  in  part:   "There  is  the                                                               
assumption  that,  at  these  doses,  radiation  doesn't  make  a                                                               
significant  contribution   ...  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."                                                                     
                                                                                                                                
CHAIR  McGUIRE  noted  that  the standards  for  what  amount  of                                                               
radiation exposure  is safe for  pregnant women has  changed over                                                               
the years.                                                                                                                      
                                                                                                                                
MR. HILYARD concurred.                                                                                                          
                                                                                                                                
5:04:21 PM                                                                                                                    
                                                                                                                                
A roll  call vote was  taken.  Representatives  McGuire Anderson,                                                               
Gruenberg,   and   Gara   voted   in  favor   of   Amendment   2.                                                               
Representatives  Wilson and  Kott voted  against it.   Therefore,                                                               
Amendment 2 was adopted by a vote of 4-2.                                                                                       
                                                                                                                                
REPRESENTATIVE  WILSON   made  a   motion  to   adopt  Conceptual                                                               
Amendment 3, which read:                                                                                                        
                                                                                                                                
     Pg 2                                                                                                                       
     after line 19 insert                                                                                                       
     (5) from a hard to serve areas [sic]                                                                                       
                                                                                                                                
REPRESENTATIVE WILSON explained that  Conceptual Amendment 3 will                                                               
address her concern regarding access  to care by exempting people                                                               
in hard  to serve  areas from the  licensure requirements  of the                                                               
bill.                                                                                                                           
                                                                                                                                
5:05:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   GRUENBERG  expressed   favor  towards   such  an                                                               
exemption, but  pointed out that  the term, "hard to  serve area"                                                               
would  have  to be  carefully  defined  because,  as is,  such  a                                                               
provision  would be  impossible to  enforce.   He suggested  that                                                               
Representative  Wilson  and the  sponsor  work  together on  this                                                               
issue.                                                                                                                          
                                                                                                                                
REPRESENTATIVE ANDERSON  objected to  Amendment 3, said  it would                                                               
gut  the bill,  and concurred  that "hard  to server  area" would                                                               
have to  be defined.  He  agreed to discuss the  issue further as                                                               
the bill continues through the process.                                                                                         
                                                                                                                                
REPRESENTATIVE   WILSON  offered   her  understanding   that  the                                                               
Department of Labor  & Workforce Development (DLWD)  knows what a                                                               
"hard to serve area" is.                                                                                                        
                                                                                                                                
REPRESENTATIVE  KOTT  indicated   agreement  with  Representative                                                               
Anderson,  and opined  that  defining the  term,  "hard to  serve                                                               
area" will  be cumbersome  and difficult.   He  said it  would be                                                               
helpful  to  see documentation  from  the  DLWD referencing  what                                                               
constitutes a hard to serve area.                                                                                               
                                                                                                                                
REPRESENTATIVE GRUENBERG  suggested crafting  a letter  of intent                                                               
stating that  the committee  wants this  issue addressed  at some                                                               
point.                                                                                                                          
                                                                                                                                
REPRESENTATIVE ANDERSON  said he  would prefer  to simply  make a                                                               
commitment  to research  this issue  further before  the bill  is                                                               
heard in its next committee of referral.                                                                                        
                                                                                                                                
REPRESENTATIVE GRUENBERG said  he would be satisfied  with such a                                                               
commitment by the sponsor.                                                                                                      
                                                                                                                                
CHAIR McGUIRE  noted that Representative Gara  has suggested that                                                               
institution of a "staggered" effective  date for a definable hard                                                               
to serve area might be a way of addressing this issue.                                                                          
                                                                                                                                
REPRESENTATIVE WILSON withdrew Amendment 3.                                                                                     
                                                                                                                                
REPRESENTATIVE KOTT  suggested the committee consider  Mr. Ford's                                                               
point  regarding  misdemeanors,  and  opined  that  the  proposed                                                               
penalties should be similar in nature.                                                                                          
                                                                                                                                
5:10:06 PM                                                                                                                    
                                                                                                                                
CHAIR  McGUIRE  asked  Representative  Kott to  describe  how  he                                                               
wished to change the bill to that effect.                                                                                       
                                                                                                                                
REPRESENTATIVE  GRUENBERG  suggested   allowing  the  sponsor  to                                                               
research this  issue further  as the  bill continues  through the                                                               
process.                                                                                                                        
                                                                                                                                
MR. HILYARD, in  response to a question, said he  didn't know why                                                               
the proposed penalties are not consistent with each other.                                                                      
                                                                                                                                
MS.  RUFSHOLM offered  her understanding  that the  drafter chose                                                               
the language  pertaining to penalties, and  said her organization                                                               
is amenable to changing that language.                                                                                          
                                                                                                                                
REPRESENTATIVE GRUENBERG  noted that  under Version  R, violation                                                               
of proposed AS 08.89.100 will be a class A misdemeanor.                                                                         
                                                                                                                                
REPRESENTATIVE GRUENBERG made  a motion to adopt  Amendment 4, to                                                               
change "class B misdemeanor" to  "class A misdemeanor" on page 8,                                                               
line 12.                                                                                                                        
                                                                                                                                
REPRESENTATIVE WILSON  said she  would rather have  any violation                                                               
be a class B misdemeanor.                                                                                                       
                                                                                                                                
REPRESENTATIVE  GRUENBERG asked  Mr. Ford  whether the  crimes of                                                               
"unauthorized  practice"  are class  A  misdemeanors  or class  B                                                               
misdemeanors.                                                                                                                   
                                                                                                                                
MR. FORD said he did not know.                                                                                                  
                                                                                                                                
REPRESENTATIVE GARA  noted that  fraud is  usually a  felony, and                                                               
said  he would  be comfortable  allowing the  sponsor to  work on                                                               
this issue before the bill is heard on the House floor.                                                                         
                                                                                                                                
CHAIR  McGUIRE noted  that sometimes  if something  is a  "lesser                                                               
included"  crime, it  will  result  in a  lower  penalty, and  so                                                               
perhaps  that was  the intent  behind having  different penalties                                                               
for different  behaviors.  She  said she  would not want  to undo                                                               
the  balance  that  the   current  statutes  regarding  penalties                                                               
provide.   She,  too,  expressed satisfaction  with allowing  the                                                               
sponsor  to research  this issue  further as  the bill  continues                                                               
through the process.                                                                                                            
                                                                                                                                
REPRESENTATIVE  ANDERSON  said he  would  work  with members  and                                                               
other interested  parties regarding  the concerns  raised, though                                                               
he cautioned  that he may  not be  able to alleviate  the concern                                                               
regarding the "rural dynamic."                                                                                                  
                                                                                                                                
5:15:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GRUENBERG moved  to report the proposed  CS for HB
150, Version  24-LS0470\R, Mischel,  1/12/06, as amended,  out of                                                               
committee  with individual  recommendations and  the accompanying                                                               
fiscal  notes.   There  being  no  objection, CSHB  150(JUD)  was                                                               
reported from the House Judiciary Standing Committee.                                                                           

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