Legislature(2003 - 2004)

03/28/2003 03:18 PM House L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
HB 186-LICENSING RADIOLOGIC TECHNICIANS                                                                                       
Number 1576                                                                                                                     
CHAIR ANDERSON announced  that the final order  of business would                                                               
be  HOUSE  BILL NO.  186,  "An  Act establishing  the  Radiologic                                                               
Technology   Board   of   Examiners;   requiring   licensure   of                                                               
occupations   relating   to  radiologic   technology,   radiation                                                               
therapy, and  nuclear medicine technology;  and providing  for an                                                               
effective date."                                                                                                                
Number 1607                                                                                                                     
The committee took an at-ease from 3:47 to 3:48 p.m.                                                                            
Number 1618                                                                                                                     
REPRESENTATIVE  LYNN  moved  to  adopt  the  proposed  CSHB  186,                                                               
Version   23-LS0380\S,  Lauterbach,   3/25/03,  as   the  working                                                               
document.   There being  no objection, Version  S was  before the                                                               
Number 1639                                                                                                                     
CHAIR ANDERSON, as the sponsor  of HB 186, explained that members                                                               
of the  [Alaska] Society  of Radiologic  Technologists approached                                                               
him  last summer  about  introducing a  bill  that would  license                                                               
radiologic technicians and create a  board of examiners.  He said                                                               
the bill has been introduced several  times in the past 10 years.                                                               
He  said  he favors  careful  scrutiny  and licensing  of  people                                                               
employed in the health care field.   He stated that an error by a                                                               
technician  doing  a  mammogram,  for example,  could  result  in                                                               
overlooking a case of breast cancer.                                                                                            
Number 1723                                                                                                                     
HEATHER  BEATY,  Staff  to Representative  Tom  Anderson,  Alaska                                                               
State  Legislature,  summarized  the   changes  in  the  proposed                                                               
committee substitute  (CS) for  HB 186.   She said  these changes                                                               
were  discussed  with staff  from  the  Division of  Occupational                                                               
Licensing.   On  page 4,  line 12,  Sec. 08.89.130,  new language                                                               
gives the  Radiologic Technology Board of  Examiners authority to                                                               
evaluate  educational programs  from out  of state.   The  bill's                                                               
original  language   required  that   all  applicants   for  full                                                               
licensure  must  have  graduated  from  an  in-state  educational                                                               
program.  The  proposed CS language provides  for graduation from                                                               
any program  that the board  decides meets the  criteria outlined                                                               
within  the section.    The  change on  page  6,  line 1-4,  Sec.                                                               
08.89.160, makes the same revision.                                                                                             
MS. BEATY explained  that another change on page 7,  line 4, Sec.                                                               
08.89.180, removes language [in  the original bill] pertaining to                                                               
a  lapse  in  licensure.     By  removing  this  subsection,  the                                                               
licensees  would   be  governed  by  the   centralized  licensing                                                               
statute, which allows  for a grace period in  renewal of licenses                                                               
and allows the  board to charge a late penalty  for renewals made                                                               
after  the expiration  date.   The  original language  in HB  186                                                               
would require  a licensee to  begin a new application  process if                                                               
there  were any  lapse in  licensure.   Ms. Beaty  explained that                                                               
this is  consistent with the  way other boards in  Alaska provide                                                               
licensure and  allows for  a small  lapse.  On  page 8,  line 10,                                                               
Sec.  08.89.300, the  words  "holding a  license  or permit"  are                                                               
added after "person."  Sec. 08.89.330  on 8, starting on line 26,                                                               
adds  language  indicating  the  board's  authority  to  deny  an                                                               
application  or renewal  of licensure  for disciplinary  reasons.                                                               
She  explained  that this  change  was  made  at the  request  of                                                               
division officials.   The last change  on page 10, line  13, adds                                                               
"dentists" as  a "licensed  practitioner" qualified  to supervise                                                               
the performance of radiologic examinations by licensees.                                                                        
Number 1929                                                                                                                     
BARBARA HUFF  TUCKNESS, Director of Legislative  and Governmental                                                               
Affairs,  General  Teamsters,  Local 959,  Alaska,  testified  in                                                               
support of HB 186  and the changes in the proposed  CS.  She said                                                               
the Teamsters represent radiologic  technologists at hospitals in                                                               
Homer  and Kodiak.    The members  support  the requirement  that                                                               
individuals working  in the  industry, whether  in a  hospital or                                                               
clinic  setting,  are  certified   and  are  therefore  able  and                                                               
eligible to perform  the tasks, whether it's  mammography, MRI or                                                               
bone density  tests.   The work  is important  because physicians                                                               
use it  to make recommendations  for the next step  in treatment.                                                               
She  said the  Teamsters  also  support the  bill  from a  public                                                               
health  and safety  perspective,  giving  patients the  assurance                                                               
that qualified people are doing the job.                                                                                        
Number 2038                                                                                                                     
CHRISTINE  LUNG,  Director   of  Government  Relations,  American                                                               
Society of  Radiologic Technologists  (ASRT), explained  that her                                                               
professional organization  was founded to promote  the proper and                                                               
safe   delivery  of   medical  imaging   and  radiation   therapy                                                               
procedures.   She  said ASRT  is concerned  about the  risks from                                                               
unnecessary radiation  exposure.  She  stated that 90  percent of                                                               
public  exposure to  radiation results  from medical  procedures,                                                               
primarily   diagnostic  x-ray   exams  performed   by  radiologic                                                               
technologists.   Ms. Lung stated  that the federal Food  and Drug                                                               
Administration, Bureau  of Radiologic  Health, estimates  that 30                                                               
percent of exposures to manmade  radiation are unnecessary, and 5                                                               
to  10  percent  of  unnecessary   exposures  are  attributed  to                                                               
repeated  x-ray exams.   She  said  that ASRT  is concerned  that                                                               
overuse as  well as the improper  use of medical radiation  is an                                                               
ever-increasing health hazard to the public.                                                                                    
MS.  LUNG  testified  that  currently  a  physician  using  x-ray                                                               
equipment in his  practice is under no obligation  to require any                                                               
credential  or specific  education of  the employee  who operates                                                               
medical  imaging or  radiation therapy  equipment.   She said  in                                                               
Alaska, anyone  off the  street can  be hired  in the  morning to                                                               
operate this potentially dangerous  equipment that the afternoon.                                                               
She said  her society  believes that HB  186 will  help alleviate                                                               
this disparity in health care.                                                                                                  
Number 2115                                                                                                                     
MS.  LUNG  said  there  are  over  400  radiologic  technologists                                                               
registered in  the State of  Alaska by a  voluntary certification                                                               
body, the  American Registry of Radiologic  Technologists (ARRT).                                                               
However,  she said,  there's no  way of  knowing how  many people                                                               
with minimal  training and no certification  are operating x-ray,                                                               
radiation  therapy,  and  other   medical  imaging  equipment  in                                                               
Alaska.    These  people are  administering  potentially  harmful                                                               
radiation  without  having   demonstrated  scientific  knowledge,                                                               
technical  understanding,  clinical competency,  or  professional                                                               
responsibility.  She said that  36 other states currently license                                                               
radiologic technologists and radiation  therapists.  She said she                                                               
hopes the State of Alaska will  join these other states in making                                                               
sure that  the people performing  medical imaging  and delivering                                                               
radiation  therapy are  properly  educated  and credentialed,  as                                                               
evidenced by being licensed.                                                                                                    
Number 2172                                                                                                                     
REPRESENTATIVE  ROKEBERG  asked  whether  the  federal  Consumer-                                                               
Patient Radiation Health and Safety  Act of 1981 requires workers                                                               
in the field to be certified.                                                                                                   
MS.  LUNG   responded  that  this  federal   law  sets  voluntary                                                               
standards for the states.  She  said that HB 186 would meet these                                                               
voluntary requirements.   She said  that her organization  and 16                                                               
other  national  societies  representing  radiation  and  medical                                                               
imaging personnel are  pursuing an amendment to  the 1981 federal                                                               
law, H.R.  1214.  This  amendment would require states  to comply                                                               
with  the law's  mandates at  the risk  of losing  state Medicaid                                                               
matching funds for radiologic procedures.                                                                                       
REPRESENTATIVE ROKEBERG  asked questions  about whether  the ASRT                                                               
provides educational courses or certifications.                                                                                 
MS.  LUNG replied  that the  ASRT  does not  provide courses  for                                                               
people  entering  the  profession   but  it  does  do  continuing                                                               
education training for registered  radiologic technologists.  She                                                               
explained  that  it  does not  offer  certifications;  rather  it                                                               
represents  professionals in  the field.   She  explained that  a                                                               
national  agency,   the  ARRT,   provides  the   examination  and                                                               
Number 2289                                                                                                                     
REPRESENTATIVE  GUTTENBERG  asked  if  HB 186  meets  a  national                                                               
standard  or  conforms  to other  state's  norms  for  radiologic                                                               
MS. LUNG replied yes.                                                                                                           
Number 2352                                                                                                                     
DONNA   RUFSHOLM,  President,   Alaska   Society  of   Radiologic                                                               
Technologists, reiterated  why the Alaska  organization requested                                                               
Representative Anderson to sponsor HB 186.   She said that HB 186                                                               
ensures that Alaskans  will have access to  safe and high-quality                                                               
radiologic care without geographical  limitations.  She cited the                                                               
problems  identified in  the written  testimony submitted  by the                                                               
State of  Alaska's radiologic health specialist.   These examples                                                               
included operators exposing patients to  as much as 60 times more                                                               
radiation than  necessary for  medical procedures;  operators who                                                               
practice  by exposing  each other  to x-rays;  unrestricted x-ray                                                               
beams;  inexperienced,  untrained   and  under-trained  personnel                                                               
performing radiologic procedures on patients.                                                                                   
TAPE 03-24, SIDE B                                                                                                            
Number 2379                                                                                                                     
MS.  RUFSHOLM  stated  that  many  patients  assume  that  people                                                               
performing  medical procedures  know what  they are  doing.   She                                                               
said  that  licensure  through  HB 186  will  give  Alaskans  the                                                               
confidence that  they'll have access  to high  quality radiologic                                                               
care whenever they go into a facility for an x-ray.                                                                             
Number 2330                                                                                                                     
REPRESENTATIVE DAHLSTROM asked about the cost of the licensing.                                                                 
CHAIR ANDERSON explained that the  fiscal note would be discussed                                                               
after the witnesses testify.                                                                                                    
REPRESENTATIVE  ROKEBERG  inquired   about  the  availability  of                                                               
trained  personnel,  particularly  in  rural Alaska.    He  asked                                                               
whether the  bill allows a  multi-tiered level of  licensure that                                                               
would assist people at the entry level of the profession.                                                                       
MS. RUFSHOLM  explained that the  University of  Alaska Anchorage                                                               
(UAA)  has  a 19-month  associate  degree  program in  radiologic                                                               
technology.   UAA is also working  with the society to  develop a                                                               
program for limited licensure so  that individuals in rural areas                                                               
can perform radiologic procedures safely and with confidence.                                                                   
Number 2238                                                                                                                     
DALE  COLLINS,  Program  Chair,  Radiologic  Technology,  Medical                                                               
Imaging  Sciences  Department,  University of  Alaska  Anchorage,                                                               
described  the  program that  started  in  2001 for  career-entry                                                               
radiographers.    Currently,  27  students are  enrolled  in  the                                                               
program,  seven  of  whom  will  graduate  in  May  as  qualified                                                               
radiographers.   They will have  the education stipulated  by the                                                               
ASRT and  well as the  competency requirements determined  by the                                                               
national registry organization,  the ARRT.  There  are classes at                                                               
UAA and at the University of Alaska Fairbanks.                                                                                  
MR. COLLINS said that UAA  will soon offer a four-month semester-                                                               
long program, which  includes three courses that  would cover all                                                               
the elements  necessary for a  limited scope of  practice license                                                               
developed by the  ARRT.  This program would fill  a training need                                                               
for staff  in rural communities  around the state.   This program                                                               
could be implemented if HB 186 passes the legislature.                                                                          
Number 2135                                                                                                                     
REPRESENTATIVE ROKEBERG  asked whether developing  the four-month                                                               
program depends on passage of this bill.                                                                                        
MR.  COLLINS  explained  that  implementing  this  curriculum  is                                                               
independent of passage of HB 186.                                                                                               
REPRESENTATIVE  ROKEBERG   asked  whether  most   health  service                                                               
providers   that  hire   people  in   this  field   require  ARRT                                                               
MR. COLLINS  said that certification of  radiologic technologists                                                               
is usually  required by the providers'  accrediting organization.                                                               
For  example, JCAHO,  the Joint  Commission  on Accreditation  of                                                               
Healthcare  Organizations,  requires  hospitals to  employ  ARRT-                                                               
registered technologists.                                                                                                       
REPRESENTATIVE ROKEBERG asked about the  impact of a $543 license                                                               
biennial fee on an entry-level technologist.                                                                                    
Number 2081                                                                                                                     
MR. COLLINS replied  that an entry-level wage  for a radiographer                                                               
ranges from  $36,000 to $40,000.   He  said the graduates  of the                                                               
UAA  program will  earn  a  minimum of  $40,000  annually in  the                                                               
Anchorage area.                                                                                                                 
Number 2002                                                                                                                     
REPRESENTATIVE DAHLSTROM  said she found answers  to her question                                                               
about the  cost of licensing on  the fiscal note.   She noted her                                                               
concerns  about  limited licenses  for  those  practicing in  the                                                               
rural  communities  but  said  she is  confident  that  the  next                                                               
committee  of referral,  the House  Health, Education  and Social                                                               
Services Standing Committee, will carefully review this issues.                                                                 
REPRESENTATIVE ROKEBERG  asked if the bill  requires the Division                                                               
of  Occupational  Licensing  to  implement  regulations  for  the                                                               
licensing of radiologic technologists.                                                                                          
Number 1967                                                                                                                     
RICK  URION,   Director,  Division  of   Occupational  Licensing,                                                               
Department  of Community  &  Economic  Development, replied  yes.                                                               
When asked whether his staff  has discussed doing advance work on                                                               
these regulations,  given the  bill's effective  date of  July 1,                                                               
2003, he answered no.                                                                                                           
REPRESENTATIVE  ROKEBERG  suggested  that the  division  consider                                                               
such  advance  work,  if  given   authority  to  proceed  by  the                                                               
Legislature.   He suggested that the  bill has not moved  in past                                                               
years  because of  its  large fiscal  note.   He  noted that  its                                                               
chances may  be improved because  a law passed several  years ago                                                               
allowing  license fees  to be  treated as  program receipts.   He                                                               
noted that  the fiscal note and  license fee of $543  is based on                                                               
400  people becoming  licensed.   He  commented that  occupations                                                               
which are regulated by boards generally have high overhead.                                                                     
CHAIR  ANDERSON advised  that members  of the  Alaska Society  of                                                               
Radiologic Technicians agreed to the $543 license fee.                                                                          
REPRESENTATIVE  ROKEBERG asked  why HB  186 is  necessary if  the                                                               
ARRT is already certifying radiologic technologists.                                                                            
Number 1800                                                                                                                     
MS.  RUFSHOLM  responded  that   the  registry  is  a  nationally                                                               
recognized board.   Individuals sit for the ARRT  exam after they                                                               
have  finished their  education  and their  clinical training  to                                                               
become radiologic technologists.  This  a voluntary exam, and the                                                               
person must meet  certain educational criteria to be  able to sit                                                               
for  this  exam  and  become  certified.    The  individuals  who                                                               
practice  in   the  rural  areas  without   proper  education  or                                                               
credentialing cannot even consider sitting for the ARRT exam.                                                                   
REPRESENTATIVE  ROKEBERG said  he  appreciates  these efforts  to                                                               
protect the  public.  Because  of the realities of  rural Alaska,                                                               
this  bill could  limit services  by medical  providers in  rural                                                               
Number 1725                                                                                                                     
MS.  RUFSHOLM  said her  group's  intent  is  not to  bar  health                                                               
services  in the  rural areas.    She explained  that the  Alaska                                                               
society is  asking that those  individuals who are  taking x-rays                                                               
in the rural areas get some  sort of education so they understand                                                               
what they are doing.   She stated that radiation is accumulative;                                                               
it's  a health  hazard if  not administered  properly.   She said                                                               
that's why the UAA is working  with her society to offer training                                                               
for  a  limited  license.    The intent  is  not  to  require  an                                                               
associate degree for everyone working in the field.                                                                             
REPRESENTATIVE  ROKEBERG asked  if having  every operator  in the                                                               
state register  with the  ARRT would  accomplish the  same thing.                                                               
He  asked  why create  a  board;  why  not require  everyone  who                                                               
operates a machine to be certified.                                                                                             
Number 1646                                                                                                                     
MS.  RUFSHOLM said  there are  other options  besides creating  a                                                               
board.   For  example,  another approach  is  having the  state's                                                               
radiation health office regulate radiologists.                                                                                  
MS. LUNG said that some  states require a radiologic technologist                                                               
to  be   registered  with   the  ARRT,   rather  than   having  a                                                               
professional  board oversee  them.   Another option  is requiring                                                               
regular inspections  of x-ray machines  on a regular basis.   She                                                               
said patients  in outlying  areas of Alaska  are entitled  to the                                                               
same  quality  of  care  that  they would  receive  in  an  urban                                                               
hospital  from   a  registered  radiologic  technologist.     She                                                               
emphasized  that radiologic  procedures are  not only  done in  a                                                               
hospital; 40  percent are done in  an outpatient setting or  in a                                                               
physician's office.   These facilities don't have  the same JCAHO                                                               
requirements of hospitals.                                                                                                      
Number 1516                                                                                                                     
REPRESENTATIVE  DAHLSTROM moved  to  report the  CS  for HB  186,                                                               
Version 25-LS0380\S,  Lauterbach, 3/25/03, out of  committee with                                                               
individual  recommendations and  the  accompanying fiscal  notes.                                                               
There being  no objections, CSHB  186(L&C) was reported  from the                                                               
House Labor and Commerce Standing Committee.                                                                                    

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