BILL NUMBER: AB 352 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JANUARY 4, 2012
AMENDED IN ASSEMBLY APRIL 15, 2011
AMENDED IN ASSEMBLY MARCH 25, 2011
AMENDED IN ASSEMBLY MARCH 14, 2011
INTRODUCED BY Assembly Member Eng
FEBRUARY 10, 2011
An act to add Chapter 7.75 (commencing with Section 3550) to
Division 2 of the Business and Professions Code, relating to
radiologist assistants.
LEGISLATIVE COUNSEL'S DIGEST
AB 352, as amended, Eng. Radiologist assistants.
Existing law, the Medical Practice Act, provides for the licensure
and regulation of physicians and surgeons by the Medical Board of
California. Existing law also provides for the certification and
regulation of radiologic technologists by the State Department of
Public Health.
This bill would enact the Radiologist Assistant Practice
Act, which would require Medical Board of
California and would prescribe the services that may be performed by
a radiologist assistant under the supervision of a qualified
physician and surgeon, as defined. The bill would establish the
Radiologist Assistant Advisory Council of the Medical Board of
California and require the council to make recommendations to the
board concerning the establishment of standards and issuance of
approval of programs for radiologist assistants. The bill would
require a prohibit a person from holding himself or
herself out as a certified radiologist assistant to
meet unless he or she meets specified licensure
and programmatic requirements, including completion of an approved
program that is certified by the board
American Registry of Radiologic Technologists , as specified.
The bill would require a radiologist assistant to pay a
licensure fee to be set by the board and deposited into the
Radiologist Assistant Fund which would be created by the bill in the
State Treasury. The bill would make it a crime for a person to
practice as a radiologist assistant or osteopathic radiologist
assistant without a license or for a radiologist assistant or
osteopathic radiologist assistant to practice outside the scope of
his or her practice, as specified, thereby imposing a state-mandated
local program. The bill would set forth disciplinary provisions and
procedures.
This bill would require the board to adopt regulations
relating to the licensure of radiologist assistants and certification
of approved programs by July 1, 2013, and would require the board to
commence licensure and certification on that date or as soon as
possible thereafter make it an unfair business
practice for any person to use the title of "certified radiologist
assistant" or any other term, including "licensed," "registered," or
"RA," that implies or suggests that the person is certified as a
radiologist assistant, if the person does not meet the requirements
described above .
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
This bill would also prescribe the services that may be performed
by a certified radiologist assistant under the supervision of a
qualified physician and surgeon, including specifying that a
certified radiologist assistant would be authorized to make initial
observations regarding the images for the qualified physician and
surgeon but would be prohibited from providing image interpretation,
providing a diagnosis, or prescribing medications or therapies.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes no .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Chapter 7.75 (commencing with Section
3550) is added to Division 2 of the Business and
Professions Code , to read:
CHAPTER 7.75. RADIOLOGIST ASSISTANTS
3550. (a) No person shall hold himself or herself out to be a
certified radiologist assistant unless he or she has done the
following:
(1) Has been certified by the State Department of Public Health as
a diagnostic radiologic technologist and has been issued a
radiologic technologist fluoroscopy permit.
(2) Has completed a radiologist assistant education program
recognized by the American Registry of Radiologic Technologists.
(3) Has been certified as a registered radiologist assistant by
the American Registry of Radiologic Technologists, or has been
certified as a radiology practitioner assistant by the Certification
Board of Radiology Practitioner Assistants.
(b) It is an unfair business practice within the meaning of
Chapter 5 (commencing with Section 17200) of Part 2 of Division 7 for
any person to use the title of "certified radiologist assistant" or
any other term, including, but not limited to, "licensed,"
"registered," or "RA," that implies or suggests that the person is
certified as a radiologist assistant, if the person does not meet the
requirements of subdivision (a).
(c) A radiologist assistant shall work under the direction and
supervision of a physician and surgeon licensed under Chapter 5
(commencing with Section 2050) and that direction and supervision
shall be within the specialty or usual and customary practice of the
physician and surgeon. A qualified physician and surgeon shall either
hold, or be exempt from holding, an operator supervisor permit
pursuant to the Radiologic Technology Act, as defined in Section 27
of the Health and Safety Code, for ionizing radiation, fluoroscopy,
or the use and handling of nuclear medicine material, as appropriate
for procedures that are being supervised. The supervising physician
and surgeon shall be physically present on the premises and available
to the radiologist assistant when medical services are rendered and
shall oversee the activities of, and accept responsibility for the
medical services rendered by, the radiologist assistant.
(d) A certified radiologist assistant may supervise a radiologic
technologist in the performance of medical imaging procedures using
fluoroscopy and is exempted from the provisions of Section 107110 of
the Health and Safety Code and Section 30463 of Title 17 of the
California Code of Regulations.
(e) A radiologist assistant may make initial observations
regarding the images for the qualified physician and surgeon, but may
not provide image interpretation, provide a diagnosis, or prescribe
medications or therapies, as defined by the American College of
Radiology.
SECTION 1. Chapter 7.75 (commencing with
Section 3550) is added to Division 2 of the Business and Professions
Code, to read:
CHAPTER 7.75. RADIOLOGIST ASSISTANTS
Article 1. General Provisions
3550. (a) In its concern with the growing shortage and geographic
maldistribution of medical imaging health care services in
California, the Legislature intends to establish in this chapter a
framework for development of a new category of health manpower
designated as the radiologist assistant.
(b) The purpose of this chapter is to encourage the more effective
utilization of the skills of radiologists or other qualified
physician and surgeons by enabling them to delegate health care tasks
to qualified radiologist assistants where this delegation is
consistent with the patient's health and welfare and with the laws
and regulations relating to radiologist assistants.
(c) It is also the intent of this chapter to license radiologist
assistants and radiologist practitioner assistants and to categorize
both groups under the title of radiologist assistant.
(d) This chapter is established to encourage the utilization of
radiologist assistants by radiologists or other qualified physician
and surgeons and to provide that existing legal constraints should
not be an unnecessary hindrance to the more effective use of medical
imaging health care services. It is also the purpose of this chapter
to allow for innovative development of programs for the education,
training, and utilization of radiologist assistants.
3550.1. This chapter shall be known and cited as the Radiologist
Assistant Practice Act.
3550.2. As used in this chapter:
(a) "Approved program" means a radiologist assistant program or a
radiologist practitioner assistant program for the education and
training of radiologist assistants that has been formally approved by
the board for the licensure of radiologist assistants.
(b) "Board" means the Medical Board of California.
(c) "Council" means the Radiologist Assistant Advisory Council of
the Medical Board of California.
(d) "Medical imaging" means any procedure intended for use in the
diagnosis or treatment of disease or other medical conditions, and
includes, but is not limited to, X-rays, nuclear medicine, and other
procedures, and that excludes echocardiography and diagnostic
sonography.
(e) "Qualified physician and surgeon" means a radiologist or
another physician and surgeon supervising a radiologist assistant
within his or her specialty or usual and customary practice. A
qualified physician and surgeon shall either hold, or be exempt from
holding, an operator supervisor permit pursuant to the Radiologic
Technology Act, as defined in Section 27 of the Health and Safety
Code, for ionizing radiation, fluoroscopy, or the use and handling of
nuclear medicine material, as appropriate for procedures that are
being supervised.
(f) "Radiologist" means a physician and surgeon licensed by the
board or by the Osteopathic Medical Board of California and certified
by, or board-eligible for, the American Board of Radiology.
(g) "Radiologist assistant" means a person who meets the
requirements of Section 3552.2 and the other requirements of this
chapter.
(h) "Radiology practitioner assistant" means a person who is
certified by the Certification Board for Radiology Practitioner
Assistants.
(i) "Regulations" means the rules and regulations as contained in
the California Code of Regulations.
(j) "Supervision" means the qualified physician and surgeon is
physically present on the premises and available to the radiologist
assistant when medical services are rendered and oversees the
activities of, and accepts responsibility for, the medical services
rendered by the radiologist assistant.
3550.3. (a) Notwithstanding any other provision of law, a
radiologist assistant licensed pursuant to Section 3552.2 may perform
those medical services as set forth by the regulations of the board
when the services are rendered under the supervision of a qualified
physician and surgeon who meets the requirements of subdivision (a)
of Section 3550.4. Those medical services performed by a radiologist
assistant shall include, but not be limited to, obtaining patient
consent prior to beginning an examination or procedure and obtaining
medical imaging necessary for diagnosis and providing initial
observations to the qualified physician and surgeon.
(b) (1) A radiologist assistant and his or her qualified physician
and surgeon shall establish written guidelines for the adequate
supervision of the radiologist assistant. This requirement may be
satisfied by the qualified physician and surgeon adopting protocols
for some or all of the tasks performed by the radiologist assistant.
Radiologist assistants shall not interpret images, make diagnoses, or
prescribe medications or therapies. The protocols adopted pursuant
to this subdivision shall comply with the following requirements:
(A) A protocol governing procedures shall set forth the
information to be provided to the patient, the nature of the consent
to be obtained from the patient, the preparation and technique of the
procedure, supervision of radiologic technologists by the
radiologist assistant in the performance of medical imaging
procedures, and followup care.
(B) Protocols shall be developed by the qualified physician and
surgeon or adopted from, or referenced to, texts or other sources.
(C) Protocols shall be signed and dated by the qualified physician
and surgeon and the radiologist assistant.
(D) Protocols shall be available at each practice site.
(2) Notwithstanding any other provision of law, the board may
establish other alternative mechanisms for the adequate supervision
of the radiologist assistant.
(c) A radiologist assistant licensed under this chapter may
supervise a radiologic technologist in the performance of medical
imaging procedures using fluoroscopy and is exempted from the
provisions of Section 107110 of the Health and Safety Code and
Section 30463 of Title 17 of the California Code of Regulations.
3550.4. (a) Notwithstanding any other provision of law, a
radiologist assistant licensed by the board shall be eligible for
employment or supervision by any qualified physician and surgeon, as
defined in subdivision (e) of Section 3550.2. A qualified physician
and surgeon shall possess a current and valid license to practice
medicine and may not be on disciplinary probation for improper use of
a radiologist assistant or subject to a disciplinary condition
imposed by the board prohibiting employment or supervision of a
radiologist assistant.
(b) No qualified physician and surgeon shall supervise more than
two radiologist assistants at any one time.
3550.5. (a) Notwithstanding any other provision of law, a
radiologist assistant may perform those medical services permitted
pursuant to Section 3550.3 during any state of war emergency, state
of emergency, or local emergency, as defined in Section 8558 of the
Government Code, and at the request of a responsible federal, state,
or local official or agency, or pursuant to the terms of a mutual aid
operation plan established and approved pursuant to the California
Emergency Services Act (Chapter 7 (commencing with Section 8550) of
Division 1 of Title 2 of the Government Code), regardless of whether
the radiologist assistant's qualified physician and surgeon is
available to supervise the radiologist assistant, so long as a
licensed physician and surgeon is available to render the appropriate
supervision. "Appropriate supervision" shall not require the
personal or electronic availability of a qualified physician and
surgeon if that availability is not possible or practical due to the
emergency. The local health officers and their designees, who are
licensed as physicians and surgeons, may act as qualified physicians
and surgeons during emergencies.
(b) No responsible official or mutual aid operation plan shall
invoke this section except in the case of an emergency that endangers
the health of individuals. Under no circumstances shall this section
be invoked as the result of a labor dispute or other dispute
concerning collective bargaining.
3550.6. No person other than one who has been licensed to
practice as a radiologist assistant shall practice as a radiologist
assistant or in a similar capacity to a radiologist or hold himself
or herself out as a "radiologist assistant."
Article 2. Administration
3551. There is established a Radiologist Assistant Advisory
Council of the Medical Board of California. The board shall create
and appoint the council consisting of qualified physician and surgeon
licensees of the board in good standing, who are not required to be
members of the board, and members of the public who have an interest
in radiologist assistant practice. At least one-half of the council
members shall be radiologist assistants certified by the American
Registry of Radiologic Technologists or radiology practitioner
assistants certified by the Certification Board for Radiology
Practitioner Assistants. The council shall make recommendations on
matters specified by the board and pursuant to Section 3551.7.
3551.6. The council may convene from time to time as deemed
necessary by the board.
3551.7. It shall be the duty of the council to do all of the
following:
(a) Make recommendations to the board concerning the establishment
of standards and issuance of approval for programs.
(b) Make recommendations to the board concerning the scope of
practice for radiologist assistants using the guidance of the
American Society of Radiologic Technologists, the American Registry
of Radiologic Technologists, the American College of Radiology, and
the Certification Board for Radiology Practitioner Assistants.
(c) Adopt regulations pursuant to Section 3552.1.
3551.8. The board may adopt, amend, and repeal regulations as may
be necessary to enable it to carry into effect the provisions of
this chapter. All regulations shall be in accordance with, and not
inconsistent with, the provisions of this chapter. All regulations
shall be adopted, amended, or repealed in accordance with the
provisions of Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code.
3552. Except as provided in Sections 159.5 and 2020, the board
shall employ within the limits of the Radiologist Assistant Fund all
personnel necessary to carry out the provisions of this chapter. The
board shall make all necessary expenditures to carry out the
provisions of this chapter from the fund established by Section 3553.
The board may accept contributions to effect the purposes of this
chapter.
Article 3. Licensure and Certification
3552.1. (a) The board shall adopt regulations consistent with
Sections 3551.7 and 3552.2 for the consideration of applications for
licensure as a radiologist assistant.
(b) The board shall adopt regulations consistent with Sections
3551.7 and 3552.3 for the certification of approved programs.
(c) The board shall adopt the regulations described in this
section no later than July 1, 2013.
3552.2. Commencing July 1, 2013, or as soon as possible
thereafter, the board shall issue a license to each radiologist
assistant applicant who meets all of the following requirements:
(a) Provides evidence of successful completion of an approved
program.
(b) Is certified as a radiologist assistant by the American
Registry of Radiologic Technologists or as a radiology practitioner
assistant by the Certification Board for Radiology Practitioner
Assistants.
(c) Is certified by the State Department of Public Health as a
diagnostic radiologic technologist and holds a radiologic
technologist fluoroscopy permit.
(d) Is not subject to denial of licensure under Division 1.5
(commencing with Section 475) or Section 3554.
(e) Pays all fees required under Section 3553.1.
3552.3. Commencing July 1, 2013, or as soon as possible
thereafter, the board shall recognize the approval of training
programs for radiologist assistants approved by a national
accrediting organization. Radiologist assistant training programs
accredited by a national accrediting agency approved by the board
shall be deemed approved by the board under this section. If no
national accrediting organization is approved by the board, the board
may examine and pass upon the qualification of, and may issue
certificates of approval for, programs for the education and training
of radiologist assistants that meet the board standards. The board
may examine and issue certificates to approved programs that satisfy
the requirements of the regulations adopted pursuant to Section
3552.1.
3552.4. The applicant shall provide evidence satisfactory to the
board that an application has been filed and accepted for the
examination and that the organization certifying radiologist
assistants has been requested to verify the applicant's certification
status to the board in order for the applicant to maintain interim
approval. The applicant shall be deemed to have failed the
examination unless the applicant provides evidence to the board
within 30 days after scores have been released that he or she has
passed the examination.
Article 4. Revenue
3553. Within 10 days after the beginning of each calendar month,
the board shall report to the Controller the amount and source of all
collections made under this chapter and at the same time pay all
those sums into the State Treasury, where they shall be credited to
the Radiologist Assistant Fund, which fund is hereby created. All
money in the fund shall, upon appropriation by the Legislature, be
used to carry out the purpose of this chapter.
3553.1. Fees to be paid by radiologist assistants for
application, licensure, and renewal shall be set by the board in an
amount sufficient to cover the reasonable and necessary costs of
implementing and administering this chapter.
3553.2. The board shall report to the appropriate policy and
fiscal committees of each house of the Legislature whenever the board
approves a fee increase pursuant to Section 3553.1.
3553.4. (a) All radiologist assistant licenses shall expire at 12
midnight of the last day of the birth month of the licensee during
the second year of a two-year term if not renewed.
(b) The board shall establish by regulation procedures for the
administration of a birth date renewal program, including, but not
limited to, the establishment of a system of staggered license
expiration dates.
(c) To renew an unexpired license, the licensee shall, on or
before the date of expiration of the license, apply for renewal on a
form provided by the board, accompanied by the prescribed renewal
fee.
3553.5. The board shall require a licensee to complete continuing
education, as deemed acceptable by the board, as a condition of
license renewal under Section 3553.4. The board shall not require
more than 50 hours of continuing education every two years.
3553.6. (a) A suspended license is subject to expiration and
shall be renewed as provided in this chapter, but that renewal does
not entitle the holder of the license, while it remains suspended and
until it is reinstated, to practice or engage in the activity to
which the license relates, or engage in any other activity or conduct
in violation of the order or judgment by which the license was
suspended.
(b) A revoked license is subject to expiration as provided in this
chapter. If the license is reinstated after expiration, the
licensee, as a condition to reinstatement, shall pay a reinstatement
fee in an amount equal to the renewal fee in effect on the last
preceding regular renewal date before the date on which it is
reinstated.
Article 5. Denial, Suspension, and Revocation
3554. (a) The board may deny, issue with terms and conditions,
suspend or revoke, or impose probationary conditions upon a
radiologist assistant license as required in Section 3554.1 for
unprofessional conduct that includes, but is not limited to, a
violation described under Section 2234, a violation of this chapter,
a violation of the Radiologic Technology Act, as defined in Section
27 of the Health and Safety Code, a violation of the applicable
regulations adopted by the board, or a breach of an ethics rule
established by a recognized national certification organization of
radiologist assistants.
(b) The board may deny, approve with terms and conditions, suspend
or revoke, or impose probationary conditions upon an approved
program after a hearing as required in Section 3554.1 for a violation
of this chapter or the regulations adopted pursuant to this chapter.
(c) The board may order the licensee to pay the costs of
monitoring the probationary conditions imposed on the license.
3554.1. Any proceedings involving the denial, suspension, or
revocation of the application for licensure or the license of a
radiologist assistant or the application for approval or the approval
of an approved program under this chapter shall be conducted in
accordance with Chapter 5 (commencing with Section 11500) of Part 1
of Division 3 of Title 2 of the Government Code.
3554.2. The board may hear any matters filed pursuant to
subdivisions (a) and (b) of Section 3554, or may assign any such
matter to a hearing officer. If a matter is heard by the board, the
hearing officer who presided at the hearing shall be present during
the board's consideration of the case, and, if requested, assist and
advise the board.
3554.3. (a) A person whose license has been revoked or suspended,
or who has been placed on probation, may petition the board for
reinstatement or modification of penalty, including modification or
termination of probation, after a period of not less than the
following minimum periods has elapsed from the effective date of the
decision ordering that disciplinary action:
(1) At least three years for reinstatement of a license revoked
for unprofessional conduct, except that the board may, for good cause
shown, specify in a revocation order that a petition for
reinstatement may be filed after two years.
(2) At least two years for early termination of probation of three
years or more.
(3) At least one year for modification of a condition,
reinstatement of a license revoked for mental or physical illness, or
termination of probation of less than three years.
(b) The petition shall state any facts as may be required by the
board. The petition shall be accompanied by at least two verified
recommendations from qualified physician and surgeons licensed either
by the board or the Osteopathic Medical Board of California who have
personal knowledge of the activities of the petitioner since the
disciplinary penalty was imposed.
(c) The petition may be heard by the board. The board may assign
the petition to an administrative law judge designated in Section
11371 of the Government Code. After a hearing on the petition, the
administrative law judge shall provide a proposed decision to the
board that shall be acted upon in accordance with the Administrative
Procedure Act.
(d) The board or the administrative law judge hearing the petition
may consider all activities of the petitioner since the disciplinary
action was taken, the offense for which the petitioner was
disciplined, the petitioner's activities during the time the license
was in good standing, and the petitioner's rehabilitative efforts,
general reputation for truth, and professional ability. The hearing
may be continued as the board or administrative law judge finds
necessary.
(e) The board or administrative law judge, when hearing a petition
for reinstating a license or modifying a penalty, may recommend the
imposition of any terms and conditions deemed necessary.
(f) No petition shall be considered while the petitioner is under
sentence for any criminal offense, including any period during which
the petitioner is on court-imposed probation or parole. No petition
shall be considered while there is an accusation or petition to
revoke probation pending against the person. The board may deny,
without a hearing or argument, any petition filed pursuant to this
section within a period of two years from the effective date of the
prior decision following a hearing under this section.
(g)
Nothing in this section shall be deemed to alter Sections 822 and
823.
3554.4. A plea or verdict of guilty or a conviction following a
plea of nolo contendere made to a charge of a felony or of any
offense that is substantially related to the qualifications,
functions, or duties of the business or profession to which the
license was issued is deemed to be a conviction within the meaning of
this chapter. The board may order the license suspended or revoked,
or shall decline to issue a license when the time for appeal has
elapsed, or the judgment of conviction has been affirmed on appeal or
when an order granting probation is made suspending the imposition
of sentence, irrespective of a subsequent order under the provisions
of Section 1203.4 of the Penal Code allowing the person to withdraw
his or her plea of guilty and to enter a plea of not guilty, or
setting aside the verdict of guilty, or dismissing the accusation,
information, or indictment.
Article 6. Penalties
3555. Any person who violates Section 3550.3 or 3550.6 shall be
guilty of a misdemeanor punishable by imprisonment in the county jail
not exceeding six months, or by a fine not exceeding one thousand
dollars ($1,000), or by both.
3555.5. Whenever any person has engaged in any act or practice
that constitutes an offense against this chapter, the superior court
of any county, on application of the board, may issue an injunction
or other appropriate order restraining the conduct. Proceedings under
this section shall be governed by Chapter 3 (commencing with Section
525) of Title 7 of Part 2 of the Code of Civil Procedure. The board
may commence action in the superior court under the provisions of
this section.
Article 7. Osteopathic Radiologist Assistants
3557. (a) Notwithstanding any other provision of law, qualified
physicians and surgeons licensed by the Osteopathic Medical Board of
California may use or employ radiologist assistants provided (1) each
radiologist assistant so used or employed is a graduate of an
approved program and is licensed by the board, and (2) the scope of
practice of the radiologist assistant is the same as that which is
approved by the Medical Board of California for radiologist
assistants in the same or similar specialty.
(b) Any person who violates subdivision (a) shall be guilty of a
misdemeanor punishable by imprisonment in a county jail not exceeding
six months, or by a fine not exceeding one thousand dollars
($1,000), or by both that imprisonment and fine.
SEC. 2. No reimbursement is required by this
act pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the meaning of
Section 17556 of the Government Code, or changes the definition of a
crime within the meaning of Section 6 of Article XIII B of the
California Constitution.