Legislature(2005 - 2006)SENATE FINANCE 532
05/06/2006 09:00 AM Senate FINANCE
| Audio | Topic |
|---|---|
| Start | |
| HB381 | |
| HB240 | |
| HB381 | |
| HB240 | |
| HB381 | |
| HB266 | |
| HB403 | |
| HB304 | |
| HB409 | |
| HB150 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 381 | TELECONFERENCED | |
| + | HB 266 | TELECONFERENCED | |
| + | HB 403 | TELECONFERENCED | |
| + | HB 304 | TELECONFERENCED | |
| + | HB 409 | TELECONFERENCED | |
| + | HB 240 | TELECONFERENCED | |
| + | HB 150 | TELECONFERENCED | |
| + | TELECONFERENCED |
SENATE CS FOR CS FOR HOUSE BILL NO. 150(L&C)
"An Act requiring licensure of occupations relating to
radiological technology, radiation therapy, and nuclear
medicine technology; and providing for an effective date."
This was the first hearing for this bill in the Senate Finance
Committee.
HEATH HILYARD, Staff to Representative Tom Anderson, the bill's
sponsor, remarked this bill would establish licensure
regulations for radiographers and radiological technologists in
the State. While some Statutes currently address the
administering of x-ray technology for medical diagnoses, no
express licensure exists. This has been an oversight for several
years.
Mr. Hilyard noted that members' packets included a list of
states that have adopted licensure or certification laws [copy
on file] similar to the provisions proposed in this bill. New
York and California adopted their radiological licensure laws as
early as the 1960s. More than a proposal to implement an
occupational licensure, this bill would address a legitimate
public health issue.
Mr. Hilyard read excerpts from a University of California,
Berkeley news release dated November 16, 1999 [copy on file] as
follows.
"This is a serious public health problem," Gofman [John W.
Gofman, professor emeritus of molecular and cell biology at
the University of California Berkeley] said. "We're talking
about the two biggest causes of death in this country -
cancer and heart disease - which together amount to 45
percent of all deaths. Medical X-rays are a major cause of
these deaths."
"There is the assumption that, at these doses, radiation
doesn't make a significant contribution," he said. "But X-
rays are very potent mutagens, even at low doses. It's a
disaster that people still believe the 'safe dose myth,'
that low doses are harmless."
Mr. Hilyard communicated that the second excerpt would address
the common misperception that low dosage X-rays are harmless.
10:17:20 AM
Mr. Hilyard concluded that the health and administrative
benefits the bill would provide are reason to support it.
Co-Chair Green asked whether the legislation would create a
board.
Mr. Hilyard responded in the negative.
Co-Chair Green asked whether a board pertinent to this subject
currently existed.
Mr. Hilyard stated no.
Co-Chair Green responded positively to the fact that no board
existed or would be created by the legislation.
Co-Chair Wilken asked what specific problem would be addressed
by this legislation.
Mr. Hilyard communicated that during the bill's House Finance
Committee hearing, a question was asked about the number of
complaints filed in this regard. While the Director of the
Division of Occupational Licensing, Department of Commerce,
Community and Economic Development expressed that none had been
filed, the reality is that the Division would not have received
any complaints because this is currently an unlicensed
occupation. Medical malpractice lawsuits have been filed against
radiologists and other medical professionals. However, without a
more thorough review of the cases, a definitive number could not
be provided. Nonetheless, "anecdotal evidence" would support
there being "a problem with overexposure, radiation burns, and,
more difficult to identify, is the problem of misdiagnoses, or
missed diagnoses as a result of improper procedures".
Mr. Hilyard reiterated there is a "significant problem but it's
very difficult to quantify".
Co-Chair Wilken remarked that the certification requirements for
large hospitals dictate they employ certified radiologists.
However, smaller facilities such as clinics, particularly those
in outlying areas, "would struggle with some of these
requirements". Thus, the question is whether the extent of the
problem would justify "putting them through the hoops to be
certified and the costs of that and the confusion" that would
accompany the licensure process.
Mr. Hilyard stated that during the bill's committee hearing
process, changes were made to address the "unique practice
elements in Rural Alaska". He affirmed larger facilities were
required to employ fully credentialed radiographers. The true
focus of the bill is "limited imagers, those are people that
have no sort of certification that we can look at to say yes, we
are confident that you have a firm understanding of the
practice" you are conducting. However, addressing that situation
must be done without diminishing the care available in Rural
Alaska. One example of that consideration is that, in the
education component, limited imagers receiving "any training
provided in a medical facility by a licensed practitioner or
radiographer is acceptable and they are eligible to take an
examination."
Mr. Hilyard stated that an amendment adopted by the Senate Labor
& Commerce Committee allowed "the definition of direct
supervision to be more open and lenient". This language is
depicted in Sec. 2, Article 3. General Provisions. Sec.
08.89.990(5) on page 11, lines 11 through 14 as follows.
(5) "direct supervision" means supervision that is on-site
or available by telephonic or electronic means; in this
paragraph, "supervision" includes demonstrations, record
review, evaluation of clinical examinations, or
communications;
Mr. Hilyard stressed there were efforts taken "to make this as
easy for Rural Alaska and the clinics out there to meet the
requirements".
10:21:57 AM
Co-Chair Green asked whether there had been any opposition to
the bill.
Mr. Hilyard noted that, while some groups have expressed
concern, none are on record in open opposition to the bill. Ed
Hall with the Physicians Assistants' Association has continued
to voice "qualified opposition to the bill". The understanding
is this resistance is based on implementation concerns, as
expressed earlier by Co-Chair Wilken. The bill's sponsor had
endeavored to work with any group having reservations about the
bill. Some of the concerns were successfully addressed and
others were not. Thus, there continues to be some qualified
opposition to the bill.
Senator Bunde, who knew both Ed Hall and a nurse practitioner in
his district, affirmed that "concerns about the financial impact
of the bill" continue to exist. Nonetheless, he would defer to
the will of the Committee.
In response to a question from Co-Chair Green, Senator Bunde
understood the financial concern was that the bill would require
a clinic to hire a certified person rather than being able to
hire and train an individual in-house.
10:24:10 AM
Mr. Hilyard clarified that the bill was amended to redefine what
would be recognized as an approved training program. This would
assist in addressing the "frequently reported extraordinary
training costs". Thus, "a clinic with a physician's assistant
who is providing the training" would meet the training
requirements.
Co-Chair Green asked whether individuals would be required to
take a test.
Mr. Hilyard stated individuals would be required to take an
examination.
10:25:00 AM
Co-Chair Wilken asked whether the Division of Occupational
Licensing had, during the bill's committee hearing process,
shared any concerns it is aware of about this issue.
Mr. Hilyard affirmed that the Division had testified on the
bill. Specific policy concerns were addressed; however, more
recent objections appear to be "philosophical" in nature. For
example, the Division testified that, "I don't believe that we
need this licensure because there's not a demonstrated need".
Mr. Hilyard stated that even though quantifying the need is
difficult, the communications received from physicians in the
State support the understanding that the problem exists and
should be addressed.
10:26:05 AM
Senator Dyson stated that in a recent conversation he had with
Dr. Richard Mandsager, Director, Division of Public Health,
Department of Health and Social Services, Dr. Mandsager conveyed
support for the bill even though the radiology field has
experienced vast equipment improvements during the past 25
years. Older equipment was known to overexpose people to
radiation. "The long term damage to folks has resulted in
greatly reduced dosages in modern equipment that certainly
limits the area of exposure and makes it far more effective."
Dr. Mandsager believed more cancers and leukemia would become
apparent in the future as the result of overexposure.
Senator Dyson voiced being "wary of licensing that seems …to be
the establishment protecting their turf against anybody else,
and guaranteeing their income stream"; however, he is respectful
of Dr. Mandsager's position in support of the legislation.
Co-Chair Green communicated the Department of Health and Social
Services' support of the bill. The Division of Occupation
Licensing was neutral on the bill.
Co-Chair Green asked whether the licensing requirement would
also apply to chiropractic office radiologists.
Mr. Hilyard affirmed it would.
10:28:28 AM
CLYDE PEARCE, Chief, Radiological Health, Department of Health
and Social Services, testified via teleconference from
Anchorage, and communicated that since he is the only person who
conducts radiation safety compliance inspections in the State,
he would be the person most likely to receive complaints.
Mr. Pearce had received "complaints from consumers about the
conduct of their procedures". The two most recent procedural
complaints pertained to two major hospitals: one in Juneau and
the other in Anchorage. He did not view this as a rural verses
urban issue, as he has witnessed "significant problems" in large
facilities in major cities.
Mr. Pearce stated negative biological affects have been found
"at much lower levels of exposure than previously believed to be
a matter of concern". Several research studies indicate that as
much as one percent of all cancers are the result of diagnostic
X-rays nationwide. Since the State does not currently require
formal operator training, "it could reasonably be expected" that
Alaska's percentages would be higher. These affects are not
obvious because the negative affects take time to manifest.
There are definite concerns, as radiological exposure has
increased. There is recognition that the level of radiation
overdosing is lower than historically thought. The State "does
not really require people to know what they are doing when they
apply this carcinogen to patients". The dangers of radiation are
not limited to patients; operators are also exposed. "Alaska
allows five times as much exposure to the general public than
the federal government or other states do. We have some serious
issues that need to be resolved there."
Mr. Pearce concurred with the expenses depicted on fiscal note
#2 from the Department of Commerce, Community and Economic
Development.
In conclusion, Mr. Pearce, on behalf of the Department of Health
and Social Services, encouraged the Committee to support the
bill.
10:31:05 AM
Co-Chair Wilken surmised that the bill would not address the two
aforementioned complaints pertaining to the two major hospitals,
as he understood radiologists working in major hospitals must be
trained and certified.
Mr. Pearce clarified that radiologists are medical doctors (MDs)
who specialize in this area of medicine. Radiological
technicians or operators are a different category of workers.
Typically, major hospitals "only hire registered technologists
or operators, separate from the MDs," due to the constraint of
credentialing regulations of the Joint Commission on
Accreditation of Hospitals. However, not all major hospitals are
accredited and therefore would not be required to hire certified
individuals. One of the two aforementioned major hospitals is
not accredited and thus would be subject to the provisions of
this bill.
Senator Olson voiced concern that the provisions of this bill
would not be uniformly applied to all medical facilities,
regardless of size. Continuing, he, a medical doctor, addressed
the sponsor's remarks regarding the dangers of heat radiation
burns, by noting there are two different types of X-ray
applications. To that point, he had never witnessed a heat
radiation burn resulting from a chest X-ray.
Senator Olson also understood that rather than having "qualified
opposition" to the bill, Ed Hall with the Physicians Assistant
Association was opposed to the bill.
Senator Olson asked the bill's sponsor to disclose the number of
documented complaints of overexposure.
Mr. Hilyard deferred to Mr. Pearce who had provided the
"evidence and information" pertaining to the bill.
Senator Olson asked Mr. Pearce to also provide the dates of the
overexposure cases.
Mr. Pearce concurred that a radiation burn would be an
occurrence more likely associated with "a major facility because
of the kind of procedure" that would be involved. This bill
would address "lower level kinds of injuries which include
cancer …" Current studies indicate that radiation has "a
negative affect on intellectual development". A Swedish study of
approximately 3,000 individuals concluded there to be a
measurable reduction in intellectual ability as a result of
diagnostic level X-ray exposures when the subject was between
one and one and a half years old. Other studies support this
concern. The problem with radiation is the "latent period" or
delay in the time in which the affects become "evident".
Examples of "really severe, gross burns" of the type being
referred to in this bill could be viewed at the Federal Drug
Administration's website at www.FDA.gov. Rather than the issue
being radiation burns, the "real issue" is that, due to the
"latent effects" of radiology, "even the practitioner, licensed
medical physicians, did not recognize the patient had been
injured at the time of the study". The effects could take years
to manifest themselves.
Mr. Pearce pointed out that even low levels, particularly in
regard to cancer, are a concern. The National Institutes of
Health (NIH) had "reaffirmed that radiation is a potent
carcinogen". Their studies indicate that one percent of all
cancers are the result of diagnostic X-rays. The conclusion of
researchers who have studied a variety of people, including
survivors of Hiroshima, is the Linear Non-Threshold (LNT)
Theory, which is that "the only safe dose is no dose at all".
"There is no fully safe dose of exposure to radiation," Mr.
Pearce stated. Any effort to keep exposures to a minimum is a
good idea. He was not recommending that people avoid getting an
examination that's done properly and ordered for clinical
reasons by practitioners. However, "we don't need to expose them
to 50 or 60 times the amount of radiation needed in order to get
that diagnostic information". He had witnessed exposures at
those levels occurring in the State.
Senator Olson pointed out that the X-ray spectrum addressed in
this bill is different than that of the Hiroshima atomic bomb.
Today's equipment has more safeguards than older machines. This
legislation is opposed by small rural clinics, as it would
further increase the difficulty they historically experience in
recruiting employees, particularly X-ray technicians. "X-rays
are one of those necessary elements of the practice of medicine
to go ahead and make a proper diagnosis." People must be able
"to have an X-ray at their disposal" in order to make a
diagnosis.
Senator Olson share never having seen a malpractice suit
"dealing with any kind of over-radiation exposure" during his
eight years on the State medical board.
10:38:51 AM
DONNA RUFSHOLM, Chair, Legislative Committee, Alaska Society of
Radiological Technologists, testified via teleconference from an
offnet location and informed the Committee that the Society was
involved in the development of this bill. One of the questions
addressed during the bill's development was "why do we need this
regulation in the State of Alaska?" The answer is "safety to the
patients, safety to the" equipment operators, "and the necessity
to establish standards" to ensure that Alaskans receive "quality
care" when undergoing X-ray examinations.
Ms. Rufsholm, a professional radiology technologist, stated,
"there is no safe dose of radiation". Low-level radiation could
be as harmful as high levels of radiation. However, patients are
unaware of these facts and do not know how to evaluate the
safety of the procedure being administered. "They place all
their confidence in the health care worker who's performing the
procedure…" They assume "that any one that is providing care in
a health care setting knows what they're doing and that they
received the proper education to perform their job."
Unfortunately this is not true in Alaska. Absent a licensure
policy, anyone, even those hired for another position, could
take an X-ray without training or with minimum training. This
scenario is occurring in numerous small facilities in the State.
Ms. Rufsholm stated that the passage of this bill "would
establish standards for individuals" conducting X-ray
procedures. The State's Radiological Health Program had
developed a listing of "documented misuse of radiation". That
list [copy not provided] included a small clinic in Anchorage
"whose staff exposed a patient to at least 64 times the amount
of radiation required to obtain a diagnostic image". The Society
"cannot blame those operators for the errors they've made", as
they are not required to receive training "to conduct their job
correctly nor have they been given the opportunity".
Ms. Rufsholm addressed the concern that this bill would create a
financial burden. The expense to a facility to license one
individual would "equate to the cost of performing one extra
procedure". This is "a small amount to pay to ensure patient
safety". Any training program "sponsored by a medical facility
supervised and instructed by a licensed practitioner or fully
licensed radiographer" would qualify as education. Additional
criteria would be established in regulation. This bill would not
alter the manner in which small rural clinics operate. The bill
was developed in recognition of the fact that rural areas of the
State have different needs than urban areas. The ability to
provide radiological services in rural areas is of paramount
importance.
Ms. Rufsholm stated major provisions were included in the bill
to ensure that individuals who were currently performing these
procedures would be able to continue to do so. Clinic services
would not be interrupted while staff received training. There
would be no loss of service or patient access to services in
rural areas. Internet training courses would also be available
for a cost of $229, which was approximately the cost of one
chest X-ray procedure.
10:43:34 AM
Ms. Rufsholm shared that studies conducted in other states
indicate the education requirement would not impact salaries and
force clinics to close. "We need to be advocates and establish
standards for persons performing radiology procedures." We
should be spokesmen for the patient. Passage of this bill would
ensure quality care and safety for individuals.
Senator Olson asked whether the dentistry profession had weighed
in on this legislation.
Mr. Hilyard replied that dentists consider themselves covered
under the Dentist Practices Act.
There being no further discussion, Co-Chair Green stated that
additional work on this legislation would be necessary.
Co-Chair Green ordered the bill HELD in Committee.
RECESS TO CALL OF CHAIR 10:44:59 AM / 4:34:02 PM
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