HOUSE BILL NO. 150 An Act requiring licensure of occupations relating to radiology technology, radiation therapy, and nuclear medicine technology; and providing for an effective date. 3:52:07 PM ED HALL, (TESTIFIED VIA TELECONFERENCE), PHYSICIAN ASSISTANT IN FAMILY PRACTICE (PA-C), REPRESENTING THE ALASKA ACADEMY OF PHYSICIAN ASSISTANTS, ANCHORAGE, testified against HB 150. He stated there has been a lack of justification to impose licensing through the bill and that there are no real facts to support the need for the bill. Historically, Physician Assistants (PA) have been portrayed as the only group against the bill. Following a round-table discussion, some concerns were addressed and some wording was changed. The final bill was not supported; that was two years ago. The bill died in the House HESS Committee. Last year, the bill was reintroduced in the House Labor and Commerce Committee and then preceded to the House Judiciary Committee. That Committee asked for more objective data and was not moved forward. Mr. Hall reiterated that the PA's have not found any harm resulting from radiation x-ray; he questioned why the bill had not been heard a second time in the House HESS Committee as it relates to health concerns. 3:55:15 PM Mr. Hall acknowledged that the cumulative affect of radiation could cause long-term harm. However, x-rays from dentistry were excluded. The Academy of Physicians Assistants supports training and has discovered evidence of training programs in place. He advised that the Alaska Native Medical Center in Anchorage receives that training. Mr. Hall referenced a handout demonstrating irresponsible advertising. (Copy on File). He discussed two antidotes: · His brother has been working at the Providence Emergency Room for 32-years and has yet heard or experienced any case of a person suffering from x-ray or radiation exposure; · He noted that his nurse attended a training program and shared her notes, indicating that x-ray exposure is minimal and that it is always important to provide quality films for reading. Mr. Hall pointed out that the bill goes "above and beyond" addressing basic x-ray. He added clinicians working in both urban and rural areas do support some sort of training. 4:00:02 PM Mr. Hall discussed the costs associated with the bill and that the costs of medical care are high and continue to rise. Mr. Hall stressed that most PA's would not be able to afford the training costs as individuals. Those clinics are the ones that serve the outlining areas of the State. Many PA's will opt not to have x-ray services because of costs associated with that training. He believed that people would, therefore receive sub-standard care. 4:01:45 PM Mr. Hall acknowledged that PA's do not totally object to the bill. They do support basic x-ray being removed. Other procedures such as MRI's and CT scans involve more than the basic x-ray skills. If that change is not made, PA's advocate a 40-hour program such as the one in place at the Alaska Native Medical Center instead of the 240 recommended hour training for an on-line education course. Mr. Hall stated that would be an adequate time to train in basic radiology and radiation safety. 4:03:32 PM Mr. Hall noted that the "physician assistant" concept was created to ease medical care costs. He pointed out that originally the bill supported a 20-hour Continuing Medical Education (CME) component. He reiterated for a basic x-ray course the time was excessive and means that employers would have to compensate the employee's time- spent training. 4:04:55 PM Mr. Hall concluded that the costs are going to be high and passage of the bill would create a health concern making access to x-ray unavailable. 4:05:19 PM LAURIE HERMAN, REGIONAL DIRECTOR, GOVERNMENTAL AFFAIRS, PROVIDENCE HOSPITAL, ALASKA STATE HOSPITAL AND NURSING ASSOCIATION (ASHNA), ANCHORAGE, testified in support of the bill. Both Providence and ASHNA are in support of the bill and have been involved in working on compromise legislation. The goal is that of strengthening the quality of imaging services provided in Alaska and achieving it without creating a workforce crisis through legislative passage. 4:06:57 PM Representative Kerttula asked about Mr. Hall's testimony regarding the 40-training hours versus the 240-hour training program. Ms. Herman needed to look at the curriculum to see what would be removed. 4:07:54 PM Representative Kerttula asked if the training was about quality versus hours. Mr. Herman thought so. 4:08:09 PM Vice Chair Stoltze mentioned conversations with Palmer doctors practicing rural medicine and that they worried about a diminished access to health care. He asked if the PA's were providing diagnostic services. Ms. Herman understood they were and has been debated over the past three years. 4:08:51 PM Vice Chair Stoltze reiterated concerns with the diagnostic sections of the bill. 4:09:16 PM Vice Chair Stoltze MOVED to ADOPT work draft #24-LS0470\B, Mischel, 2/20/06, as the version of the bill before the Committee. There being NO OBJECTION, it was adopted. HEATH LEDYARD, STAFF, REPRESENTATIVE TOM ANDERSON, commented on the changes made to work draft \B: 4:10:30 PM Page 2, Lines 20-26: The sponsor included language exempting medical personnel in the military and United States (US) Public Health Service, a standard statutory exemption. The language was taken directly from the same exemption for physicians found in AS 08.64.370. Alaska Legal Services recommended it would be appropriate to include the language because State statute cannot supersede federal law. Further, the sponsor noted that the federal government has licensing and training requirements that exceed those included in the bill. The change was included in response to concerns expressed by the Alaska Native Health Board. 4:13:16 PM Page 5, Line 31 & Page 6, Lines 1-12: A new section was included, detailing standards for the examination for a limited radiological imager. The section stipulates that the Department must provide the exam at regular intervals to provide maximum access for applicants; the exam will be based on the American Registry of Radiology Technologists (ARRT) examination in consultation with the State Medical Board, the Alaska Society of Radiology Technologists, the office of Radiology Health in the Department of Health and Social Services, and a resident member of the American College of Radiology with a minimum passing score of 75%. The change resulted from discussions with the Alaska State Medical Association. 4:13:23 PM Page 6, Lines 27-29: New (b) replaces (b) and (c) of the previous version-24-LS0470\N. That section places one standard for the issuance of a temporary permit. The new language states that a temporary permit is valid for two years from the date of issuance. The change resulted from comments made by the Alaska Primary Care Association (APCA). 4:14:21 PM Co-Chair Chenault asked the affect the changes would have on the fiscal note. Mr. Ledyard did not know. The change would create a two-year delay effective date and once the license was obtained, it would be permanent. He deferred to Mr. Urion from the Department of Commerce, Community & Economic Development. 4:15:05 PM Representative Kerttula inquired about the 240-hour requirement. Mr. Ledyard thought that the Department would measure that concern. He added that had been included in the "N" version as well and mentioned there was concern regarding that. The "B" version on Page 5, Line 16 contains the program approval for the radiological imager. That language was included to alleviate those concerns. He referenced Line 25. The intent of that language provides that any training under a licensed practiconer and sponsored by a medical facility, constitutes training. The 240-hour reference is from the on-line training program only. It is one option but not a requirement. 4:16:43 PM Vice Chair Stoltze asked the health risk difference between a dental hygienist and the person affected through the legislation. Mr. Ledyard stated that his understanding was based on testimony from one of the supporting physicians and that on average, dental x-rays are roughly 1/10 or less the amount of the exposure of medical x-rays. 4:17:27 PM Vice Chair Stoltze wondered why there were so many lobbyists with conflicting views on the legislation. He voiced concern how it would affect the under-represented population of Alaska. 4:18:35 PM Vice Chair Stoltze MOVED to ADOPT new conceptual Amendment #1. Co-Chair Meyer OBJECTED. Vice Chair Stoltze addressed the changes: Page 6, Lines 17-19, deleting all material. Page 6, Line 17, inserting: (A) Is enrolled in a program for the area approved under AS 08.89.160 and pays the appropriate fee; or (B) Demonstrates to the satisfaction of the department that the applicant has been performing limited scope radiology diagnostic imaging under AS 08.89.150(b) for two years preceding July 1, 2008 and pays the appropriate fee; or SUZANNE CUNNINGHAM, STAFF, REPRESENTATIVE KEVIN MEYER, explained that during the review of the "B" version, there was concern with the temporary permit. In the revision of that statute, it was noticed that a certain class of people were being "caught in the middle" demonstrating to the Department, two years of limited scope radiology diagnostic imaging. The intent with the amendment was to guarantee that those people would still be able to obtain a limited permit under statute. 4:20:42 PM Representative Weyhrauch asked why the imaging could not be addressed under "A or B". Ms. Cunningham replied under Section A, the limited permit would be for a person enrolled in a program, paying the appropriate fee. The full permit is for a person who has taken the examination and is waiting for the results. There was concern that if the bill passed, it has a two year delayed effective date; hence, a person with two previous years experience, who could be eligible to receive a full permit after taking the exam, would not be able to have a temporary permit to work. Representative Weyhrauch pointed out that the language says, "passed the exam". Ms. Cunningham noted that they would be waiting for the exam results under #2, Subsection (A). Representative Weyhrauch pointed out Section 150(B). 4:22:03 PM Mr. Ledyard added that in version "B" before the Committee and with regard to the temporary permit, item (1) applies only to those seeking a temporary permit for limited radiological imaging. He noted that 150(B) refers to qualifications for limited radiology imagers. In drafting the committee substitute, the intent was not to create disparity between those persons who had two years previous experience and those who did not and was intended to create a two-year temporary partial permit. Drafting that, an error was noticed, which left some people in "limbo" that could have experience. The amendment makes a change to allow those people the opportunity to obtain a temporary permit while waiting for their results. 4:24:18 PM Co-Chair Meyer WITHDREW his OBJECTION to the amendment. There being NO further OBJECTION, new Amendment #1 was adopted. 4:25:08 PM Co-Chair Meyer asked if there were new fiscal notes. Mr. Ledyard stated he did not at this time and that the Division has not yet had an opportunity to prepare the new note. Co-Chair Chenault asked if there was on-line testimony to speak to the fiscal note. RICK URION, DIRECTOR OCCUPATIONAL LICENSING, DEPARTMENT OF COMMUNITY AND ECONOMIC DEVELOPMENT, said he could not address the new note at this time. AT EASE: 4:26:05 PM RECONVENE: 4:27:58 PM 4:28:05 PM Co-Chair Meyer maintained concern with not having the revised fiscal note in Committee. He advised that if the bill does pass Committee, it would not be transmitted to the Clerk's office until the appropriate fiscal note was available. He asked the impact the proposed changes would have on the note. Mr. Urion stated that the law requires the Department to charge the licensees to manage that program. Whatever the fiscal note is would not include general fund monies. Mr. Urion directed his testimony to the collection of fines, as supported by fees not fines. Co-Chair Meyer requested that issue be discussed at a later date. 4:29:52 PM Representative Weyhrauch questioned how many complaints the Division receives every year from radiology technicians. Mr. Urion responded that the Division had never received a complaint. 4:30:31 PM Representative Foster MOVED to REPORT CS HB 150 (FIN) out of Committee with individual recommendations and with the accompanying fiscal notes. Vice Chair Stoltze OBJECTED. A roll call vote was taken on the motion. IN FAVOR: Holm, Joule, Kerttula, Weyhrauch, Foster, Hawker, Meyer, Chenault OPPOSED: Moses, Stoltze Representative Kelly was not present for the vote. The MOTION PASSED (8-2). CS HB 150 (FIN) was reported out of Committee with a "no recommendation" and with a new fiscal note by the Department of Commerce, Community & Economic Development. 4:33:02 PM