BILL ANALYSIS
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|Hearing Date:June 22, 2009 |Bill No:AB |
| |356 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: AB 356Author:Fletcher
As Amended:June 15, 2009 Fiscal: Yes
SUBJECT: Radiologic technology: licentiates of the healing arts.
SUMMARY: Includes physician assistants in the definition of
licentiates of the healing arts that are authorized to perform
specified radiologic technology functions authorized by the Radiologic
Technology Act under the supervision of a qualified physician and
surgeon; allows a physician and surgeon to delegate to a licensed
physician assistant procedures using fluoroscopy.
Existing law:
1)Establishes the Radiologic Health Branch within the Department of
Public Health (DPH) to administer a radiation control program,
including licensing of radioactive materials, registration of
X-ray-producing machines, certification of medical and industrial
X-ray and radioactive material users, inspection of facilities using
radiation, investigation of radiation incidents, and surveillance of
radioactive contamination in the environment.
2)Establishes the the Radiologic Technology Act (RT Act) to establish
standards for the education, training, and experience for persons
who use radiation on human beings and to prescribe means for
assuring that these standards are met.
3)Requires DPH to appoint a certification committee, referred to as
the Radiologic Technology Certification Committee (RTCC), to assist,
advise, and make recommendations for the establishment of
regulations necessary to insure the proper administration and
enforcement of the radiation control law.
4)Defines a radiologic technologist (RT) as any person, other than a
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licentiate of the healing arts, making application of X-rays to
human beings for diagnostic or therapeutic purposes, as specified.
5)Requires DPH to provide for the certification of RTs, provided that
applicants submit satisfactory completion of a course of study in an
approved school for RTs or an equivalent course of study from an
approved school.
6)Makes it unlawful for any person to administer or use diagnostic or
therapeutic X-ray on human beings unless that person is certified or
granted a permit , as specified, is acting within the scope of that
certification or permit, and is acting under the supervision of a
licentiate of the healing arts.
7)Defines licentiate of the healing arts as a physician and surgeon,
an osteopathic physician and surgeon, podiatrist or a chiropractor,
and defines supervision as the responsibility for, and control of,
quality radiation safety, and technical aspects of all X-ray
examinations and procedures.
8)Provides for exemptions from this prohibition, including exemptions
for licentiates of the healing arts, as defined, and students in an
approved school for RTs and in schools of medicine, podiatry, or
chiropractic, when the students are operating X-ray machines under
the supervision of an instructor, as specified.
9)Provides for granting of limited permits, as prescribed, to persons
to conduct radiologic technology, but only limited to the
performance of certain procedures or the application of X-rays to
specific parts of the body.
10) Indicates that a radiologic technologist fluoroscopy permit
issued by DPH is required of any technologist who exposes a patient
to X-rays in a fluoroscopy mode, or who does one or more of the
following during fluoroscopy of a patient: positions the patient,
positions the fluoroscopy equipment and selects exposure factors.
11) Requires that to obtain a radiologic technologist fluoroscopy
permit, an applicant must file with the DPH an application, pass
DPH-approved examinations in fluoroscopy radiation protection and
safety and use of fluoroscopy and ancillary equipment.
12) Provides that a fluoroscopy supervisor and operator permit
issued by DPH shall be required of any licentiate of the healing
arts who does one or more of the following: a) actuates or energizes
fluoroscopy equipment; b) directly controls radiation exposure to
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the patient during fluoroscopy procedures; and, c) supervises one or
more persons who hold radiologic technologist fluoroscopy permit, as
specified.
13) Provides for the regulation and licensing of physician
assistants by the Physician Assistant Committee of the Medical Board
of California (MBC).
14) Authorizes a physician assistant to perform those medical
services as set forth by the regulations of the MBC when the
services are rendered under the supervision of a licensed physician
and surgeon.
15) Requires a physician assistant and his or her supervising
physician and surgeon to establish written guidelines for the
adequate supervision of the physician assistant, including adopting
protocols for some or all of the tasks performed by the physician
assistant, and specifies requirements for the protocols that may be
adopted and provides that a physician and surgeon can only supervise
four physician assistants, as specified.
16) Authorizes a physician assistant, while under the supervision of
a licensed physician and surgeon to administer or provide medication
to a patient, or transmit orally, or in writing on a patient's
record or in a drug order, as specified.
17) Requires physician assistants to complete 50 hours of continuing
education every two years as a condition of license renewal.
This bill:
1)Revises the definition of licentiates of the healing arts who are
allowed to practice pursuant to the RT Act to include physician
assistants licensed under the Physician Assistant Practice Act and
who practices under the supervision of a qualified physician and
surgeon.
2)States that in order to supervise a physician assistant in
performing the functions authorized by the RT Act, a physician and
surgeon must either hold, or be exempt from holding a licentiate
fluoroscopy permit required to perform the functions being
supervised.
3)Allows a physician and surgeon to delegate to a licensed physician
assistant procedures using fluoroscopy; requires that a physician
assistant, to whom a physician and surgeon has delegated the use of
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fluoroscopy, to demonstrate successful completion of 40 hours of
total coursework, including fluoroscopy radiation safety and
protection recognized by the DPH.
4)Requires that documentation of completed coursework to be kept on
file at the practice site and available to the DPH upon request and
requires DPH to accept applications for a fluoroscopy permit from a
licensed physician assistant who meets the requirements, as
specified.
5)States that nothing in this bill shall be construed to remove the
need for a physician assistant to pass a DPH-approved examination in
fluoroscopy radiation safety and protection, as specified.
6)Requires a licensed physician assistant who is issued a fluoroscopy
permit to, in the two years preceding the expiration date of the
permit, earn 10 approved continuing education credits and requires
the DPH to accept continuing education credits approved by the
Physician Assistant Committee.
7)States that nothing in the bill is to be construed to do the
following:
a) Authorize a physician assistant to perform any other
procedures utilizing ionizing radiation except those authorized
by holding a licentiate fluoroscopy permit.
b) Remove the need for a physician assistant to be subject to the
licentiate fluoroscopy permit requirements approved by DPH, as
specified.
FISCAL EFFECT: According to the Assembly Appropriations Committee
analysis, absorbable workload to DPH to continue oversight of
diagnostic imaging professional proficiency.
COMMENTS:
1.Purpose. According to the California Academy of Physician
Assistants (CAPA), the sponsor of this bill, while existing law
allows supervising physicians to delegate the ordering and
performing of various diagnostic tests to physician assistants,
these physician assistants cannot do any fluoroscopic procedures
without first being certified as an RT by the Radiologic Health
Branch. CAPA states that this restriction is inconsistent with the
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scope of practice of physician assistants, which allows them to act
as an agent of supervising physicians in performing most other
medical services. Physician assistants generally need to use
ionizing radiation to use fluoroscopy for visualization during a
medical procedure. This is especially important in settings such as
rural and underserved clinics and hospitals where keeping a licensed
RT on staff may not be practical or possible. No viable options
currently exist for a licensed physician assistant in California to
utilize fluoroscopic equipment without completing an RT program and
taking the fluoroscopic permit exam. CAPA states that California is
in the midst of an access to care crisis and restrictions like these
in existing law overburden physicians with routine duties that
should be performed by clinically competent physician assistants.
Particularly in medically underserved areas, it is not always
practical for a physician to be available at all times.
2.Background.
a) Scope of Practice of Physician Assistants. Physician
assistants are medical practitioners who perform services under
the supervision of physicians and surgeons. The scope of
practice of a physician assistant is described in the Physician
Assistant Practice Act and in regulations promulgated by the MBC.
A physician assistant and supervising physician and surgeon are
required to establish written guidelines for the adequate
supervision of the physician assistant, including the adoption of
protocols for some or all of the tasks performed by a physician
assistant. Existing law also requires that protocols adopted to
comply with specified requirements. In addition, physician
assistants while under the supervision of a licensed physician
and surgeon may administer or provide medication to a patient, or
transmit orally, or in writing on a patient's record or in a drug
order, an order to a person who may lawfully furnish the
medication or medical device, as specified.
b) Radiologic Technology Act. The Radiologic Health Branch
(Branch) within DPH is responsible for the oversight and
regulation of the use of radiological equipment in California,
subject to the recommendations of the RTCC. The Branch is
responsible for providing public health functions associated with
administering a radiation control program. This includes
licensing of radioactive materials, registration of
X-ray-producing machines, certification of X-ray and radioactive
material users, inspection of facilities using radiation,
investigation of radiation incidents, and surveillance of
radioactive contamination in the environment. In addition, it
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requires that radiologic technologists be certified. The Branch
also certifies physicians, technologists, and technicians who use
X-ray machines and radioactive materials on human beings, and
approves radiologic technology schools.
Existing law prohibits any person from administering or using
diagnostic or therapeutic X-ray on anyone unless that person has
been certified as radiologic technologists or granted a permit,
as specified, is acting within the scope of that certification or
permit, and is under the supervision of a licentiate of the
healing arts. DPH grants limited permits to persons to conduct
radiologic technology limited to the performance or the
application of X-rays to specific areas of the human body.
Existing law also provides for the certification of licentiates
of the healing arts to supervise the operation of X-ray machines
or to operate X-ray machines, prescribe minimum standards of
training and experience of these licentiates of the healing arts,
and prescribe procedures for examining applicants for
certification.
c) Fluoroscopy. This measure would allow a physician and surgeon
to delegate to a licensed physician assistant procedures using
fluoroscopy. According to the federal Food and Drug
Administration (FDA), fluoroscopy is a type of medical imaging
that shows a continuous X-ray image on a monitor, much like an
X-ray movie. It is used to diagnose or treat patients by
displaying the movement of a body part or of an instrument or dye
(contrast agent) through the body. During a fluoroscopy
procedure, an X-ray beam is passed through the body. The image
is transmitted to a monitor so that the body part and its motion
can be seen in detail. According to the FDA's website,
fluoroscopy is used in many types of examinations and procedures,
including catheter insertion to direct the placement of a
catheter during angioplasty and angiography, blood flow studies,
and orthopedic surgery. The two major risks associated with
fluoroscopy are radiation-induced injuries to the skin and
underlying tissues, and the small possibility of developing a
radiation-induced cancer some time later in life.
3.Arguments in Support. The Medical Board of California writes in
support of this bill and states that this bill will help expand
access to care for consumers.
SUPPORT AND OPPOSITION:
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Support:
California Academy of Physician Assistants (sponsor)
Medical Board of California
Opposition: None on file as of June 17, 2009.
Consultant:Rosielyn Pulmano