BILL ANALYSIS                                                                                                                                                                                                    




                   Senate Appropriations Committee Fiscal Summary
                           Senator Christine Kehoe, Chair

                                           356 (Fletcher)
          
          Hearing Date:  7/6/2009         Amended: 6/15/2009
          Consultant:  Bob Franzoia       Policy Vote: B,P&ED 10-0
          _________________________________________________________________ 
          ____
          BILL SUMMARY: AB 356 would authorize a physician and surgeon to  
          delegate procedures using fluoroscopy to a licensed physician  
          assistant (PA) if the PA completes 40 hours of total coursework.  
           In addition, this bill would require the supervising physician  
          and surgeon to have, or to be exempt from having, a fluoroscopy  
          license permit to perform the functions that he or she is  
          supervising.
          _________________________________________________________________ 
          ____
                            Fiscal Impact (in thousands)

           Major Provisions         2009-10      2010-11       2011-12     Fund
           PA diagnostic imaging              Up to $390*         Up to  
          $280           $140 - $280   Special**
          permit program

          * Includes one time mailing cost of $250
          ** Radiation Control Fund (4265-0075)        
          _________________________________________________________________ 
          ____

          STAFF COMMENTS: This bill may meet the criteria for referral to  
          the Suspense File.
          
          The purpose of this bill is to allow PAs to conduct fluoroscopy  
          procedures under the supervision of a physician and after  
          completing training.  Under current law, PAs are authorized to  
          provide medical services consistent with their education,  
          training, and supervision.  Fluoroscopy imaging obtains real  
          time moving images of the internal structures of a patient via  
          an x-ray and fluorescent screens between which a patient is  
          placed.

          The PA fluoroscopy permit would be issued and overseen by the  
          Department of Public Health (DPH) which administers a radiation  
          control program which includes, among other things, the  
          registration of x-ray producing equipment.  The fiscal impact is  










          based on 6,000 applicants (approximately five percent of the  
          estimated 125,000 persons that would be contacted via an initial  
          mailing).  Costs would likely decline in future years.  The  
          initial license fee would likely be up to $75 with a renewal fee  
          of $25 to $50.  Staff recommends this bill be amended to specify  
          that DPH has the authority to charge permit fees sufficient to  
          offset the costs of the program.