Legislature(2005 - 2006)CAPITOL 17
03/18/2005 03:15 PM House LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| HB147 | |
| HB150 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 147 | TELECONFERENCED | |
| += | HB 150 | TELECONFERENCED | |
| *+ | HB 196 | TELECONFERENCED | |
| *+ | HB 203 | TELECONFERENCED | |
| *+ | HB 216 | TELECONFERENCED | |
HB 150-LICENSING RADIOLOGIC TECHNICIANS 4:36:13 PM CHAIR ANDERSON announced that the next 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." The committee took an at-ease from 4:36 PM to 4:40 PM. 4:41:08 PM JON BITTNER, Staff to Representative Anderson, Alaska State Legislature, in response to concerns that were raised at the last committee hearing for HB 150, presented an amendment which would include dental hygienists and dental assistants in the license and permit exemption on page 2, line 2 of the bill. CHAIR ANDERSON moved to adopt Amendment 1, labeled 24- LS0470\Y.5, Mischel, 3/18/05, which read: Page 2, following line 2: Insert new paragraphs to read: "(1) a licensed practitioner; (2) a dental hygienist or dental assistant who uses equipment emitting radiation on humans under the direct supervision of a licensed practitioner;" REPRESENTATIVE LEDOUX asked if Amendment 1 is simply an exemption for a licensed practitioner. MR. BITTNER replied affirmatively and explained that the proposed paragraphs 1 and 2 add the words "licensed practitioner" and "dental hygienist or dental assistant" to the exemption. [There being no objection, Amendment 1 was adopted.] MR. BITTNER presented a brief overview HB 150, explaining: This bill is aimed at protecting Alaskans from excessive exposure to radiation; not just patients but also providers as well. This bill is congruent with nationwide efforts of the Institute of Health Care Improvement and is supported by efforts of the joint commission of accreditation of health care organizations, which is the national accreditation body for 4,000 hospitals, the American Medical Association, the American Nurses Association, the Centers for Medicare and Medicaid services, the Veterans' Administration, Providence Alaska Medical Center, the Alaska State Hospital and Nursing Home Association, and the American Society of Radiologic Technologists. Both patients and providers deserve the highest level of safety and training available, and HB 150 provides that. 4:44:36 PM ALEX MALTER, MD, Alaska State Medical Association (ASMA), stated that he is a past president of ASMA and an internist in private practice in Juneau. He provided the committee members with a letter from Paul Worrell, MD, President, ASMA, which he read for the record: The Alaska State Medical Association represents physicians statewide and is primarily concerned with the health of Alaskans. [The Alaska State Medical Association] has historically supported and advocated for the best health care for all our patients. House Bill 150 provides for a system for the licensure of radiologic technicians. [The Alaska State Medical Association] supports this effort to attempt to provide for safe, quality care. However, ASMA is concerned with an unintended consequence that may detract from timely access to care. Rural physicians and small practices may have x-ray capabilities to provide for the occasional x-ray. However, the volume of that service is not sufficient to be able to hire fully certified radiologic technicians. Physicians in small practices have historically trained other clinic staff to do those uncomplicated x-rays. House Bill 150 would eliminate that mode of practice. Keeping in mind that the employing physician is ultimately responsible legally for the acts of the employee who takes the x-ray. To eliminate this current practice will certainly slow down the care provided and probably add to costs. Perhaps an alternative would be to provide a registration system (as opposed to full licensing system) for [such] people providing x- ray service when in the employ of a physician. This would allow the current practice to continue, yet provide for state oversight. REPRESENTATIVE ROKEBERG commented that the legislature has in the past used "Bush exemptions" for areas of the state that are not on the road or ferry system. He noted that this exemption may not work for HB 150 because there may be small towns that are on the road system that still need this exemption. 4:47:55 PM DR. MALTER agreed and remarked that even small practices in Juneau would run into some of the aforementioned problems. He noted that he takes one or two x-rays per day in his office, and currently those x-rays are taken by trained staff members. REPRESENTATIVE LYNN commented that though the physician is responsible, a patient can still get injured by an x-ray machine. DR. MALTER responded that by taking on the responsibility for the x-ray operators, the physicians ensure that the lab techs are doing a good job. CHAIR ANDERSON remarked that the local universities now have training programs for the x-ray technicians. 4:51:38 PM REPRESENTATIVE CRAWFORD pointed out that damage to a body by x- rays isn't always readily apparent, and "the only thing that protects people is the knowledge that the [operator] had the training ... to correctly administer the x-rays in the first place." DR. MALTER agreed that people can be exposed to high levels of radiation while receiving full body x-rays or CT scans, which are essentially performed by radiologists. However, he remarked that he didn't think that the people receiving a simple, single x-ray in a physician's office are exposed to the same dangers. He explained that he can x-ray an individual in his office to see if he/she has bronchitis or pneumonia; if HB 147 passed as is, he would not have this ability. He would instead have to send the patient to the hospital for the x-ray, which would take more time and money. He also pointed out that in a small town like Skagway the patient would have to get on a plane or ferry and come to the hospital in Juneau for the x-ray. DR. MALTER continued, "While I understand that it might sound good that there's going to be a 12 hour internet-based course to get partial certification, my understanding is that it's not delineated in this bill; that would be dependent upon whatever board or group is going to be overseeing this coming up with that plan or program." He also expressed disappointment that ASMA was not invited to participate in a working group that met last summer regarding these issues. 4:56:12 PM CHAIR ANDERSON read from his original intent letter for HB 150, which said: A report prepared for [Department of Health and Human Services (HHS)] by the national toxicology program, NTP, at the National Institute of Environmental Health Sciences said [that] X-radiation and gamma radiation were listed "because human studies show that exposure to these kinds of radiation causes many types of cancer including leukemia and cancers of the thyroid, breast, and lung." The report added that exposure to x-radiation and gamma radiation has shown to cause cancer of the salivary glands, stomach, colon, bladder, ovaries, central nervous system, and skin. And finally, it also stated that 55 percent of worldwide exposures from low-dose medical diagnoses such as bone, chest, and dental x-rays. 4:57:12 PM REPRESENTATIVE LEDOUX commented that Amendment 1 exempts dental hygienists and assistants as long as they are using equipment under the direct supervision of a licensed practitioner. She asked Dr. Malter if there is any difference between the amount of radiation that a dental assistant would be using and the radiation used by a lab technician in a physician's office. DR. MALTER replied that he did not know the difference. He stated, "All these groups come in and start a program and folks want to have licensure, but if ... we end up requiring licensure of too many groups ... you end up having a situation where the cost may become prohibitive for some small practices to keep all these folks licensed." REPRESENTATIVE LEDOUX remarked that her doctor in Kodiak had expressed the same concerns. REPRESENTATIVE KOTT asked Mr. Malter if he was trained to take x-rays during his studies to become a physician. DR. MALTER replied that most [physicians'] programs have a stint in radiology to learn how to read the simplest x-rays, but do not do extensive training in taking the x-rays. He said that when small clinics get their laboratories certified by the Division of Public Health, the division goes through the lab's checklists and training lists to ensure that the lab is meeting statewide standards. REPRESENTATIVE KOTT commented, "If you were a one-person office, could you perform the responsibilities of an x-ray technician?" DR. MALTER replied affirmatively. 5:02:33 PM REPRESENTATIVE PEGGY WILSON, Alaska State Legislature, testified in opposition to HB 150. She voiced concern for small clinics that are on the road system but are still too far from a large hospital for individuals to travel for a simple x-ray. She presented the example of the town of Tok, Alaska where she worked in a clinic for four years. At this clinic, x-rays were not run every day, but only when there was an accident or someone was sick. She said that it would be a big hardship for the patient and the ambulance crew if they had to drive four hours each way to and from Fairbanks to go x-rays. This would add cost to the small clinics. Also, the training might cost around $800, which she pointed out is a lot of money. She commented, "I just think that you need to be really aware that it's a hardship in many different ways that maybe the consequences we don't even know yet." 5:05:18 PM CHAIR ANDERSON commented that studies in California found that healthcare costs did not increase when licensure was required. He noted that 41 other states have passed legislation similar to this. He said that the licensure process only requires three on-line courses, and would not be required for another five years. REPRESENTATIVE WILSON stated, "Because of the distance and because of the time that it takes to get different places, we usually make allowances in ... many areas of things that we do in this state." She asked if anyone knew how many x-radiation accidents have been documented in Alaska; she commented that she didn't think there were many, "if any at all." 5:09:07 PM JIM TOWLE, Executive Director, Alaska Dental Society, testified in support of Amendment 1 to HB 150. 5:11:38 PM STEVEN WAHL, MD, Tok Community Clinic, testified in opposition to HB 150. He commented: I feel the burden very likely could eliminate x-ray technology from Bush and rural clinics including possibly Tok Clinic, where I practice. That could have an impact on the level of health care that's available to the people here, both in acute care and in long-term care. The burden of traveling 400 miles to obtain an x-ray that currently is readily available with treatment that can be rendered with response to that x-ray, ... is going to have a far greater negative impact on the overall health of Alaskans than the few potential situations of excessive radiation exposure. There is a potential that you could drive advanced practitioners like myself from the Bush; if I lost my ability to do x-ray technology in Tok, I very likely would leave this community and this community would no longer have a physician. So there are very widespread ramifications that need to be considered for Bush and rural Alaska. DR. WAHL continued: I think our current practices are safe, and I would like to hear specific testimony of specific cases of routine office x-rays that have led to adverse outcomes to individuals to balance that against the huge potential for misdiagnosis, minor injuries that would be neglected because of people who didn't want to travel the distance to get their treatment, and so on. ... I'm not saying that there may not need for licensure in more advanced practices or in more technical settings, but office-based x-ray, I think, is currently being practiced safely in numerous clinics statewide, and that needs to be taken into account in this bill or you're going to have a very widespread effect on health care in the Bush. DON SMITH, PA, Wasilla Medical Clinic, testified in opposition to HB 150. He noted that he is a co-owner of clinics in Wasilla and in Anchorage, and opined that the bill will adversely affect both clinics even though they are in urban areas. He predicted that if the bill passed, it would create a bottleneck in clinics with patients coming to the clinic, then going to x-ray facility, and then going back to the clinic. He also commented that as a physician assistant (PA), he has had more training for reading x-rays rather than taking them. He opined that it is a poor assumption that a PA or any licensed practicioner has the ability to physically take x-rays. TIMO SAARINEN, Alaska Society of Radiologic Technologists, testified in support of HB 150. He commented that Congress has tried to make sure that all states do "quality care as far as radiation is concerned" to make sure that all states are on the same standard. He said that the intent of this bill is to make sure that everybody is trained to the same level, and that the operator and the patient receive minimum radiation exposure. He remarked: There was a tri-state leukemia survey done which indicated that children of chronic diseases were at special risk from low x-rays. ... Children of mothers x-rayed during pregnancy suffer 1.5 times the leukemia rate as children of mothers not x-rayed. Another analysis showed the young adults with asthma, severe allergies, heart disease, diabetes, arthritis, and so on, were about 12 times as susceptible to radiation- related leukemia as were healthy adults. CHAIR ANDERSON closed public testimony. 5:18:35 PM CHAIR ANDERSON noted that physicians, physician assistants, nurse practitioners, podiatrists, osteopaths, dentists, dental hygienists, dental assistants, and chiropractors can operate x- ray machinery under this bill. REPRESENTATIVE ROKEBERG suggested that the committee allow for a more liberal transition period rather than make a rural exemption to the bill. REPRESENTATIVE LEDOUX moved to adopt Conceptual Amendment 2 to "exempt technicians working under the direct supervision of a licensed practitioner." CHAIR ANDERSON objected to Conceptual Amendment 2 because he said that the amendment would gut the intent of the bill. 5:23:47 PM A roll call was taken. Representatives LeDoux and Kott voted in favor of Conceptual Amendment 2. Representatives Crawford, Rokeberg, Lynn, Anderson voted against it. Representative Guttenberg was absent for the vote. Therefore, Conceptual Amendment 2 failed by a vote of 2-4. REPRESENTATIVE LEDOUX moved to adopt Conceptual Amendment 3, which would exempt technicians working in communities with a population of less than 1,000 which are either off the road system or over 100 miles from a metropolitan statistical area in excess of 50,000 people. 5:27:42 PM CHAIR ANDERSON objected to Conceptual Amendment 3. A roll call was taken. Representatives LeDoux and Kott voted in favor of Conceptual Amendment 3. Representatives Crawford, Rokeberg, Lynn, Anderson voted against it. Representative Guttenberg was absent for the vote. Therefore, Conceptual Amendment 3 failed by a vote of 2-4. REPRESENTATIVE KOTT commented that he hopes the bill will be further amended in the next committees. He said, "If we had a qualified physician who had a registered technician that was under the direct supervision of that physician, I don't think I'd have a problem. Just because someone is certified and licensed doesn't necessarily mean you're not going to get bad treatment." REPRESENTATIVE KOTT moved to report HB 150 out of committee as amended with individual recommendations and the accompanying fiscal notes. REPRESENTATIVE ROKEBERG objected. He stated his support for Representative Kott's previous comments and he assured Representative LeDoux and Representative Wilson that "their concerns are not falling on deaf ears." He withdrew his objection. There being no objection, CSHB 150(L&C) was reported from the House Labor and Commerce Standing Committee.
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