BILL ANALYSIS
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THIRD READING
Bill No: AB 356
Author: Fletcher (R)
Amended: 8/17/09 in Senate
Vote: 21
SENATE BUSINESS, PROF. & ECON. DEVELOP COMM : 10-0, 6/22/09
AYES: Negrete McLeod, Wyland, Aanestad, Corbett, Correa,
Florez, Oropeza, Romero, Walters, Yee
SENATE APPROPRIATIONS COMMITTEE : 11-0, 7/6/09
AYES: Kehoe, Cox, Corbett, Hancock, Leno, Price, Runner,
Walters, Wolk, Wyland, Yee
NO VOTE RECORDED: Denham, Oropeza
ASSEMBLY FLOOR : 77-0, 5/21/09 (Consent) - See last page
for vote
SUBJECT : Radiologic technology: licentiates of the
healing arts
SOURCE : California Academy of Physician Assistants
DIGEST : This bill 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, and
allows a physician and surgeon to delegate to a licensed
physician assistant procedures using fluoroscopy.
CONTINUED
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ANALYSIS : 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. 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.
4. 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.
5. 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.
6. 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.
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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
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.
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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.
8. Allows DPH to charge applicants for a fluoroscopy
permit fees sufficient to offset the costs of the
program.
Background
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.
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
Radiologic Technology Certification Committee. The Branch
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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 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.
Fluoroscopy . This bill allows 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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
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**
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permit program
* Includes one time mailing cost of $250
** Radiation Control Fund (4265-0075)
SUPPORT : (Verified 7/22/09)
California Academy of Physician Assistants (source)
Medical Board of California
ARGUMENTS IN SUPPORT : According to the California
Academy of Physician Assistants (CAPA), 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 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.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Beall, Bill
Berryhill, Tom Berryhill, Blakeslee, Block, Blumenfield,
Brownley, Buchanan, Caballero, Charles Calderon, Carter,
Chesbro, Conway, Cook, Coto, Davis, De La Torre, De Leon,
DeVore, Duvall, Emmerson, Eng, Evans, Feuer, Fletcher,
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Fong, Fuller, Furutani, Gaines, Galgiani, Garrick,
Gilmore, Hagman, Hall, Harkey, Hayashi, Hernandez, Hill,
Huber, Huffman, Jeffries, Jones, Knight, Krekorian, Lieu,
Logue, Bonnie Lowenthal, Ma, Mendoza, Miller, Monning,
Nestande, Niello, Nielsen, John A. Perez, V. Manuel
Perez, Portantino, Price, Ruskin, Salas, Silva, Skinner,
Smyth, Solorio, Audra Strickland, Swanson, Torlakson,
Torres, Torrico, Tran, Villines, Yamada, Bass
NO VOTE RECORDED: Fuentes, Nava, Saldana
JA:nl 7/22/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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