Legislature(2005 - 2006)BELTZ 211
04/27/2006 01:30 PM Senate LABOR & COMMERCE
| Audio | Topic |
|---|---|
| Start | |
| Regulatory Commission of Alaska | |
| Workers’ Compensation Appeals Board | |
| HB122 | |
| HB389 | |
| HB409 | |
| HB377 | |
| HB150 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 122 | TELECONFERENCED | |
| + | HB 409 | TELECONFERENCED | |
| + | HB 389 | TELECONFERENCED | |
| + | HB 377 | TELECONFERENCED | |
| + | HB 150 | TELECONFERENCED | |
2:08:32 PM HB 150-LICENSING RADIOLOGIC TECHNICIANS CHAIR CON BUNDE announced HB 150 to be up for consideration and that it had a number of amendments that addressed the concerns they had heard. HEATH HILYARD, staff to Representative Tom Anderson, sponsor of HB 150, explained that it establishes a full and partial professional licensure for radiologic technologists and other providing radiation X-ray examinations. The consistent question asked by many committees was why this bill was necessary. Obviously, the sponsor believes it is necessary and he pointed out that 33 states currently have full licensure of a similar nature; seven others also have regulation in place to establish credentials or licensure for these professionals. The Unites States federal government has similar professional requirements in its GS descriptions, but they are a little more stringent. MR. HILYARD emphasized, though, that aside from the policy issue of licensures in general, there really is a greater public health concern. A 1999 University of California Berkeley report by Robert Sanders related how John W. Gofman, professor emeritus of molecular and cell biology at UC Berkeley, conducted an intensive analysis comparing death rates in each of the country's nine census divisions with the average number of physicians per 100,000 people in these divisions. He said: 'This is a serious public health problem,' Gofman said. 'We're talking about 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 those deaths.' Further, on page 2, it also states 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 that low doses are harmless. MR. HILYARD stated that the sponsor worked with a number of groups - the Alaska State Medical Association, the State Medical Board (which hasn't taken a position on this bill) and a number of health care provider industry groups in developing this bill. With the amendments before them, he felt that all of their concerns were addressed. CHAIR BUNDE moved Amendment 1 and objected for discussion purposes. 4-LS0470\WA.1 Mischel A M E N D M E N T 1 OFFERED IN THE SENATE TO: CSHB 150(FIN) am Page 2, lines 8 - 9: Delete all material. Renumber the following paragraphs accordingly. SENATOR SEEKINS also objected for discussion. MR. HILYARD explained that Amendment 1 removes dental assistants (who would be under the direct supervision of a dentist) from the list of exemptions that was originally requested by the Alaska Dental Society. However, the Dental Society changed its position after ongoing discussions with the Board of Dentistry about scopes of practice within the dental profession. So, at this point, it wants that language removed - primarily because they want to deal with some of those questions internally. CHAIR BUNDE removed his objection and asked if there were further questions about Amendment 1. SENATOR SEEKINS asked what happens to dental assistants in two years. MR. HILYARD replied if the board doesn't do anything through regulation to address the scope of practice for dental assistants, they would be required to get some sort of licensure. SENATOR SEEKINS asked what kind of license. MR. HILYARD replied that it would depend on what level of X-ray they were performing. Most likely dental assistants would be required to receive the limited licensure. SENATOR SEEKINS asked if the effective date of the bill was two years out and if the Dental Association said it would be responsible for dental assistants who make diagnostic X-rays to have met the requirements of the limited license. MR. HILYARD replied that he was correct about the effective date and at this point they were hoping Amendment 1 would clarify that the dental assistants could perform the X-ray procedures. The dental hygienists can perform those procedures, but dental assistants couldn't. SENATOR SEEKINS asked if he was aware of any objection to that at any level. MR. HILYARD replied that the Dental Society requested the original language about dental assistants and then requested to have it removed. That section does not apply to the dental hygienists. Language in another provision on page 2, line 10, says that dental hygienists remain covered and can continue to perform the X-rays. SENATOR SEEKINS said it appears that one amendment speaks to the definition of direct supervision and asked if that was Amendment WA.4. He asked if the supervision could be telephonic or by electronic means. MR. HILYARD replied that was correct. CHAIR BUNDE indicated there were no further objections and Amendment 1 was adopted. 2:17:10 PM CHAIR BUNDE moved to adopt Amendment 2 and objected for an explanation. 24-LS0470\WA.2 Mischel A M E N D M E N T 2 OFFERED IN THE SENATE TO: CSHB 150(FIN) am Page 2, line 15, following "medicine,": Insert "or a program for physician assistant or advanced nurse practitioner training," Page 2, lines 15 - 16: Delete "or college" Insert ", college, or program" MR. HILYARD pointed out that line 15 of the first amendment says that "a program for a physician assistant or advanced nurse practitioner training" was requested by the Alaska Primary Care Association. Its argument was that many of those training programs do include training in X-ray technology and the sponsor wanted to provide for the fact that students in those programs would be authorized to do the examinations as long as it was under the direct supervision of a licensed practitioner. CHAIR BUNDE said he knew that physician assistants have to work under the direction of a medical doctor, but he thought advanced nurse practitioners had less direct supervision. MR. HILYARD responded that that was his understanding, as well, but he pointed out that this applies only to the students that are currently in those programs. CHAIR BUNDE asked how students enrolling the day after the effective date would be dealt with. MR. HILYARD replied that those students would be covered in the exemption. CHAIR BUNDE removed his objection and Amendment 2 was adopted. 2:19:04 PM CHAIR BUNDE moved to adopt Amendment 3 and objected for discussion purposes. 24-LS0470\WA.3 Mischel A M E N D M E N T 3 OFFERED IN THE SENATE TO: CSHB 150(FIN) am Page 2, lines 29 - 31: Delete all material. Reletter the following subsection accordingly. MR. HILYARD said the sponsor removed that language because the definition for "direct supervision" had been revised in the definitions section. This section is problematic because it's not truly a definition under "safely and appropriately". CHAIR BUNDE removed his objection and Amendment 3 was adopted. 2:20:36 PM CHAIR BUNDE moved Amendment 4, and objected for discussion purposes. 24-LS0470\WA.4 Mischel A M E N D M E N T 4 OFFERED IN THE SENATE TO: CSHB 150(FIN) am Page 11, lines 14 - 15: Delete all material and insert: "(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 explained that this changes the definition of "direct supervision" and defines what constitutes physical presence. Practitioners from rural areas have expressed concern that perhaps some of the limited licensure practitioners at the time this bill goes into effect may not have a licensed practitioner in their presence on site. There is an ongoing debate about what constitutes physical presence. This definition came from direct supervision for audiologists and would alleviate most of their concerns. 2:22:14 PM SENATOR SEEKINS pointed out that adding "means" on line 3 turns it into a definition. CHAIR BUNDE removed his objection and Amendment 4 was adopted. [Amendments 5 and 6 were not offered.] CHAIR BUNDE moved to adopt Amendment 7. 24-LS0470\WA.7 Mischel A M E N D M E N T 7 OFFERED IN THE SENATE TO: CSHB 150(FIN) am Page 2, lines 5 - 7: Delete "if the practitioner certifies to the department on a form prepared by the department that the practitioner has obtained education or training to ensure the exam or test is performed safely" 2:23:12 PM MR. HILYARD explained that this removes language that was added on the floor of the other body. At the time the amendment was made, it wasn't understood what the practical affect would be on the licensed practitioners. The desire was to ensure the maximum level of safety for the patient. It appears that it would be overly burdensome according to the Alaska State Medical Association and the Physicians and Surgeons. SENATOR SEEKINS said it appeared to him that it would say someone who would otherwise be required to get a license doesn't have to get a license as long as they certify they have obtained education. MR. HILYARD replied in looking at the exemptions as a whole, licensed practitioners, as defined in the definition section, do not require an additional licensure. CHAIR BUNDE removed his objection and Amendment 7 was adopted. CHAIR BUNDE moved to adopt Amendment 8 and objected briefly. 24-LS0470\WA.8 Mischel A M E N D M E N T 8 OFFERED IN THE SENATE TO: CSHB 150(FIN) am Page 5, line 10, following "imaging": Insert ", including peripheral bone densitometry," MR. HILYARD explained that Amendment 8 established that limited radiologic imagers would also be able to perform peripheral bone densitometry. He added that he didn't know the difference between peripheral and central densitometry, but that would be the subject of the next amendment. The Alaska Society of Radiologic Technicians and the Alaska State Medical Association came up with compromise language that was also supported by chiropractors. Basically it adds another type of procedure that the limited imagers are capable of performing. CHAIR BUNDE removed his objection and Amendment 8 was adopted. 2:26:21 PM CHAIR BUNDE moved to adopt Amendment 9 and objected for discussion purposes. 24-LS0470\WA.9 Mischel A M E N D M E N T 9 OFFERED IN THE SENATE TO: CSHB 150(FIN) am Page 5, following line 11: Insert "(2) may perform central bone densitometry if certified by a credentialing organization recognized by the department;" Renumber the following paragraphs accordingly. MR. HILYARD explained that limited imagers would be able to perform central densitometry examinations if they have a credential from an organization recognized by the department. They would need an additional credential to perform this type of procedure in addition to their imaging license. CHAIR BUNDE removed his objection and Amendment 9 was adopted. 2:27:39 PM RICK URION, Director, Division of Corporations, Businesses and Professional Licensing, Department of Commerce, Community & Economic Development (DCCED), said he had no official position on the bill, but he did have some concerns. He explained that at one time the bill affected 900 people (to be licensed), but now it affects only 400 people. He said the reason for the licensure law is for public safety. So, it seems that all 900 people should still be included if public safety was the concern. He said also that the bill affects people who are already voluntarily hiring certified people. He said hospitals have to hire certified technicians to maintain their accreditation. It seems that the bill is a farce because it exempts all doctors and dentists who deliver most of the radiation and over half the other people who deliver radiation. MR. URION added that the purpose of the bill is that people are being over-radiated. He related a personal anecdote about how he was radiated by licensed professionals in Seattle. He asked the operator if it was possible for him to over radiate him. He answered no, the machine determines the amount of radiation every 8 seconds, not the operator. 2:30:15 PM SENATOR BEN STEVENS asked the licensing procedure for manufacturing of the X-ray equipment. MR. URION replied that he didn't know, but the state has one inspector that rates X-ray machines for hospitals and doctors - once every six years. Another person checks the dentists' equipment. He thought the machines should be looked at more often than every six years. SENATOR BEN STEVENS remarked that he was sure the U.S. Patent Office would have multiple qualifications for a machine that could emit dangerous levels of radiation. 2:32:02 PM CLYDE PEARCE, Inspector, Department of Health and Social Services (DHSS), said he is the one state inspector for X-ray equipment. While he did some federal inspections under contract with the Food and Drug Administration related to mammography, the federal government has a couple of inspectors who inspect facilities under the Indian Health Service. He said the hospitals tend to hire credentialed people, but quite a few clinics hire others without formal training - "with some pretty alarming results." He said that Mr. Urion was correct in that the computer determines to a large extent the exposure received, but none of the automated aspects of equipment can account for incorrect positioning of the patient and things like that. He thought the bigger problem was how the machines were used. MR. PEARCE said the Food and Drug Administration regulates the manufacture of X-ray machines, but once the machines are installed it's up to the states to regulate who operates them and what training they must have. 2:34:16 PM MR. PEARCE had considerable concerns that the National Institute of Health recently reconfirmed that X-rays are carcinogenic and that the levels of exposure to this kind of radiation have been increasing nationwide - and in Alaska - since 1971 even though the trend has been to digitize the equipment. What's more, he emphasized, exposure levels necessary to cause harmful biological effects have been found to be a lot less than previously believed. Research now shows nationwide that 1 percent of cancers may be attributed to diagnostic X-ray overexposure. However, his observations during routine inspections in Alaska suggest that is probably a low figure in Alaska where over-exposures are common. He rarely finds a problem with the machines, but sees a lot of problems with how they are operated. More than 90 percent of excessive exposures are due to operator ignorance or carelessness or lack of due care in selecting the quantity of this carcinogen that is being administered to patients. MR. PEARCE said the fact that 80 percent of the states already license operators is a good indication this is the most effective approach to protecting patients, the operators themselves, the public and the unborn baby. He concluded saying the Department of Health and Social Services supported this bill. CHAIR BUNDE thanked him for his work and his testimony. 2:36:42 PM ED HALL, Alaska Academy of Physician Assistants, opposed HB 150 as currently written, although the adopted amendments took care of some concerns. He explained that physician assistants are required to be in a collaborative plan with their physicians. He said they are not against educating anybody for shooting X-rays, but they have not found one case where someone has been pulled in off the streets and been pointed to the equipment and told to go start shooting X-rays - as some testimony has alleged. He was concerned about requiring a large number of training hours. In the past the bill had a program that implemented a 240-hour program, but the Alaska Native Medical Center has 40- hour training program, which has proved to be quite adequate. Adding more training hours would also add more cost. MR. HALL argued that the continuing education aspect for a limited radiographer isn't necessary because they have already been trained in the correct technique for each machine. There is no advantage to make nurses maintain continuing medical education in regards to radiography over and above what their specialty already requires them to do. Once they are certified and trained, there is no evidence that recertifying and charging another license fee every two years is going to make them a better technician. Previously, continuing education was stated to be 20 hours every two years and then it was changed to whatever the department deemed appropriate. He supported a 40-hour training program, because quite a few clinics have people shoot X-rays who have not gone through formal training, but he did not support anything that could be convoluted into extended hours. MR. HALL said he had already been told this would be a deal- killer, but if they are truly interested in the safety aspect of things, he suggested separating limited radiographers and requiring them to get training. He also stated that if this bill passes, the increased costs would be passed on to the patients. 2:43:55 PM DONNA RUFSHOLM, Chair, Legislative Affairs Committee, Alaska Society of Radiology Technologists, said they wrote HB 150 out of concerns for the safety to the patients and the operators of the equipment and the necessity to establish standards that would assure that all Alaskans receive quality care when they have X-ray examinations taken. MS. RUFSHOLM explained that she has training and knows that X- rays are carcinogenic and that no level is harmless, but the general public doesn't know that. They place all their confidence in the health care workers and don't know how to evaluate the safety of the procedure they are getting. The average patient assumes that anyone who takes his X-ray knows what he is doing and has received the proper amount of education to perform his job. However, Ms. Rufsholm said, "We found this is not true in all areas of the state." She related that Mr. Pearce had a letter that addressed some of the issues he has seen on his inspections where the exposure rates to the patient were too high, where the operators were actually exposing each other to radiation and a list of other things that were not meeting expected standards. Passing HB 150 would establish standards for individuals performing X-ray exams - standards that don't exist in some of clinical areas. Opponents of HB 150 say that it is a financial burden, but an online program has been identified with the cost of $229 per individual. HB 150 would not change the way small rural clinics operate. It has been recognized that people in rural areas of the state have different needs than those in the urban areas and a number of changes have been made to the bill to accommodate the specific needs of the clinics. She stated this will not cause people in rural clinics to lose their jobs; the clinics will have no interruption of service while the staff receives training; training is available on- line. There would be no loss of service in rural areas or a reduction in patient access to quality and complete clinic care. Requiring operators to be trained and tested does not increase cost, does not restrict access to patients, will not increase salaries, will not force clinics to close, will not cause staffing shortages, will not create burdensome financial obligations to clinics and the training can be completed at the place and time convenient to the operators. 2:48:23 PM MS. RUFSHOLM said that online programs have been identified that a person can watch anywhere. Provision was also made for any training programs sponsored by a medical facility, supervised and instructed by a licensed practitioner or fully licensed radiographer to be submitted as a curriculum to the department for approval. A 40-hour program that Mr. Hall's nurse attended could qualify under that provision. There is no minimum hour requirement at this point. People who have already received training have been exempted. 2:50:32 PM CHAIR BUNDE thanked everyone for their testimony and held HB 150 for further review. There being no further business to come before the committee, he adjourned the meeting at 2:51:38 PM.
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