BILL ANALYSIS
AB 356
Page 1
Date of Hearing: April 28, 2009
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Mary Hayashi, Chair
AB 356 (Fletcher) - As Amended: April 23, 2009
SUBJECT : Radiologic technology: licentiates of the healing
arts.
SUMMARY : Permits a physician and surgeon to delegate
procedures using fluoroscopy to a licensed physician's assistant
(PA), as specified. Specifically, this bill :
1)Adds a licensed PA practicing under the supervision of a
physician and surgeon, as specified, to the category
"licentiates of the healing arts" who practice pursuant to the
Radiologic Technology (RT) Act.
2)Requires a physician and surgeon, in order to supervise a PA
in performing the functions authorized by this bill, to either
hold, or be exempt from holding, a licentiate fluoroscopy
permit required to perform the functions being supervised.
3)Permits a physician and surgeon to delegate procedures using
fluoroscopy to a licensed PA if the PA demonstrates successful
completion of 40 hours of total coursework, including
radiation safety and protection, recognized by the department.
4)Requires that documentation of completed coursework must be
kept on file at the practice site and be available to the
Department of Public Health (DPH) upon request.
5)Requires, notwithstanding any other provision of law, DPH to
accept applications for a licentiate fluoroscopy permit from a
licensed PA who meets the requirements of this bill.
6)Requires a PA with a licentiate fluoroscopy permit to earn 10
approved continuing education credits in the two years
preceding the expiration date of the permit.
EXISTING LAW :
1)Establishes the RT Act, administered by DPH, to establish
standards of education, training, and experience for persons
who use radiation on human beings and to prescribe means for
AB 356
Page 2
assuring that these standards are met.
2)Requires DPH to provide for the certification of radiologic
technologists (RTs), provided that applicants submit
satisfactory evidence to DPH that they have satisfactorily
completed a course of study in an approved school for RTs, or
have completed study and training in radiologic technology
that DPH finds equivalent to a course of study from an
approved school.
3)Defines a licentiate, for purposes of the RT Act, as a
licensed physician and surgeon, podiatrist, or chiropractor.
4)Requires, in regulations, applicants for a licentiate
supervisor and operator permit to successfully pass a
DPH-administered examination in the permitting category and
pay a specified examination fee. Authorizes, in regulations,
a licentiate supervisor and operator permitholder to supervise
RTs.
5)Provides for the regulation and licensing of PAs by the
Physician Assistant Committee (PAC) of the Medical Board of
California (MBC).
6)Allows a PA to perform those medical services as set forth by
the regulations of MBC when the services are rendered under
the supervision of a licensed physician and surgeon, as
specified.
7)Specifies, in regulations, the medical services that a PA may
perform pursuant to a delegated services agreement (DSA) such
as taking a patient history; ordering or transmitting an order
for X-ray; ordering, transmitting an order for, performing, or
assisting in the performance of laboratory, screening, and
therapeutic procedures; instructing and counseling patients;
initiating arrangements for hospital admissions; administering
or providing medication; issuing or transmitting drug orders
as specified; and, performing those surgical procedures
without the personal presence of the supervising physician
that do not require general anesthesia.
FISCAL EFFECT : Unknown
COMMENTS :
AB 356
Page 3
Purpose of this bill . According to the author's office, "While
existing law allows supervising physicians to delegate the
ordering and performing of various diagnostic tests to PAs,
these PAs cannot explicitly use fluoroscopy as they are not
allowed to sit for the Radiologic Health Branch (RHB)- DPH
exams. This restriction is inconsistent with the scope of
practice of physician assistants, which allows them to act as an
agent of supervising physicians in performing most other medical
services."
Background . The Radiologic Health Branch within DPH is
responsible for the oversight and regulation of the use of
radiological equipment in California. RHB provides public
health functions associated with administering a radiation
control program and enforces the RT Act. The RT Act establishes
standards of education, training, and experience for persons who
use radiation on human beings and RHB ensures that these
standards are met. Among its many functions, RHB certifies
personnel in the supervision and use of diagnostic and
therapeutic X-ray, including licentiates, i.e. physicians and
surgeons, podiatrists, and chiropractors; and, RTs. Individuals
who perform X-ray procedures in radiography (standard X-ray) and
fluoroscopy (live movement X-ray) are required to obtain
operator permits from DPH, unless they are radiologist
physicians, non-radiologist physician and surgeons, podiatrists,
or chiropractors.
Current regulations specify that a PA may only provide those
medical services which he or she is competent to perform, as
determined by a supervising physician, that are consistent with
the PA's education, training, and experience. These medical
services must be delegated in writing by the supervising
physician responsible for the patients cared for by the PA. The
DSA is required to be signed and dated by the PA and supervising
physician, which identifies what types of services the PA is
allowed to perform, how they are performed, how patient charts
will be reviewed and signed, and what type of medications the PA
will transmit on behalf of the supervising physician. A PA may
provide medical services pursuant to more than one DSA. Every
practicing PA is required to have a DSA and make a copy
available upon the request of the MBC. Failure to have a
current DSA constitutes a violation and is grounds for
disciplinary action.
Medical tasks performable by a PA may only be those that are
AB 356
Page 4
usual and customary to the supervising physician's practice.
Examples of such medical services include taking patient
histories; ordering or transmitting orders for X-rays;
initiating arrangements for hospital admissions; completing
forms and charts for a patient's medical record; issuing or
transmitting drug orders under specified conditions; and,
performing surgical procedures that are customarily performed
under local anesthesia. This bill includes procedures using
fluoroscopy within the medical services that may be delegated to
a PA.
REGISTERED SUPPORT / OPPOSITION :
Support
California Association of Physician Assistants (CAPA) (sponsor)
Opposition
California Chiropractic Association (as amended April 13th)
Analysis Prepared by : Sarah Huchel / B. & P. / (916) 319-3301