Legislature(2005 - 2006)CAPITOL 17

03/18/2005 03:15 PM House LABOR & COMMERCE


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 147 INSURANCE TELECONFERENCED
Heard & Held
+= HB 150 LICENSING RADIOLOGIC TECHNICIANS TELECONFERENCED
Moved CSHB 150(L&C) Out of Committee
*+ HB 196 ALTERNATIVE ENERGY PROJECT LOANS TELECONFERENCED
Scheduled But Not Heard
*+ HB 203 MOTOR VEHICLE DEALER SALES TELECONFERENCED
<Bill Hearing Postponed to Mon. 3/21/05>
*+ HB 216 PROPERTY/CASUALTY INSURANCE REGULATION TELECONFERENCED
<Bill Hearing Postponed to Mon. 3/21/05>
Bills Previously Heard/Scheduled
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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