BILL ANALYSIS �
AB 352
Page 1
Date of Hearing: January 10, 2012
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Mary Hayashi, Chair
AB 352 (Eng) - As Amended: January 4, 2012
SUBJECT : Radiologist assistants.
SUMMARY : Establishes a title act for Radiologist Assistants
(RA's). Specifically, this bill :
1)States that no person shall hold himself or herself out to be
a certified RA unless he or she has done the following:
a) Has been certified by the State Department of Public
Health (DPH) as a diagnostic radiologic technologist (RT)
and has been issued a RT fluoroscopy permit;
b) Has completed a RA education program recognized by the
American Registry of Radiologic Technologists (ARRT); and,
c) Has been certified as a registered RA by the ARRT, or
has been certified as a radiology practitioner assistant by
the Certification Board of Radiology Practitioner
Assistants.
2)Makes it an unfair business practice, as specified, 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 RA, if the person does not meet the
requirements of 1), above.
3)Requires a RA to work under the direction and supervision of a
licensed physician and surgeon and requires that direction and
supervision to 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, 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 RA
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when medical services are rendered and shall oversee the
activities of, and accept responsibility for the medical
services rendered by, the RA.
4)Allows a certified RA to supervise a RT in the performance of
medical imaging procedures using fluoroscopy and exempts a
certified RA from current law and regulations governing
certification requirements for licentiates of the healing arts
in the administration or use of diagnostic, mammographic or
therapeutic X-rays on human beings, as specified.
5)Allows a RA to make initial observations regarding the images
for the qualified physician and surgeon, but specifies that a
RA may not provide image interpretation, provide a diagnosis,
or prescribe medications or therapies, as defined by the
American College of Radiology (ACR).
EXISTING LAW
1)Regulates and licenses physicians and surgeons, including
radiologists, under the Medical Board of California within the
Department of Consumer Affairs (DCA).
2)Establishes within DPH the Radiologic Health Branch (RHB),
which is responsible for 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.
3)Requires certification or licensure for any person who
administers or uses diagnostic, mammographic or therapeutic
X-ray.
4)Specifies examination requirements for obtaining a RT
certificate and requires passage of a DPH-approved examination
in diagnostic radiologic technology.
5)Allows DPH to issue limited permits for the performance of
radiologic technology limited to certain procedures or the
application of X-rays to specific areas of the human body,
except for mammography.
6)Provides for a number of remedies and penalties for unfair
competition, including unfair business practices.
AB 352
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FISCAL EFFECT : Unknown
COMMENTS :
Purpose of this bill . According to the author, "Since 1992 the
number of procedures radiologists perform every year has
increased over twenty-five percent?This increased demand for
services takes Radiologists away from interpreting the results
from an imaging device and from making diagnoses. Radiologists
are becoming overwhelmed with the volume of other procedures
that need to be performed in their field?
"AB 352 will ensure that anyone who calls themselves a certified
RA will have the necessary education, training, and skills to
legitimately refer to themselves as a RA. It will allow
educated and trained professionals to assist radiologists with
their workload to increase the quality of care for patients
throughout California."
Background . According to the ACR, an RA is identified as an
"advanced-level radiologic technologist who works under the
supervision of a radiologist to enhance patient care by
assisting the radiologist in the diagnostic imaging environment.
The RA is not a radiologist nor a physician assistant but
rather a valuable addition to the radiology team who can enhance
quality patient care by performing advanced level radiological
services under the supervision of a radiologist."
"The term was developed during a series of meetings between the
American Society of Radiologic Technologists (ASRT) and the ACR
during the spring and summer of 2002. The two groups have been
meeting to consider the development of an advanced-level
radiologic technologist to address workforce shortages among
radiologic technologists and radiologists."
According to ASRT, several universities pioneered the idea for
RA programs in the 1970s, but the concept did not take hold.
"The shortage of radiologists, along with growing demand for
imaging services, motivated the ACR to look for alternative ways
of continuing to provide high quality patient care. The ASRT
was looking for ways to extend the career path of radiologic
technology in order to support recruiting and retention efforts.
The two initiatives found a common solution in the radiologist
assistant concept."
AB 352
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Currently, there is no RA license or title protection in
California. There is only the RT practice, which is certified
by DPH. RTs must complete an educational program approved by
RHB and pass a state examination, or a national examination, for
certification.
RTs generally obtain a two-year associate's degree in radiologic
technology. After obtaining their degree, students are eligible
to take the state examination for a diagnostic or therapeutic RT
certificate. They are also eligible to take the national
examination for a therapeutic radiologic technology certificate.
Both examinations are given by the ARRT. Successful passage of
either the state or national examination qualifies RTs to x-ray
any part of the body. Those who obtain state certification may
also apply for additional certificates, such as a RT fluoroscopy
permit or a mammographic radiologic technology certificate, if
they meet appropriate educational requirements. RTs may also
become certified in radiation therapy technology through the
ARRT.
A document published in 2003 by the Center for the Health
Professions at the University of California San Francisco (UCSF)
identified a shortage of diagnostic imaging professionals. A
2001 American Hospital Association study reported a 15.3%
vacancy rate for imaging technologists and technicians, with the
highest rate at 17% on the west coast. The study also revealed
that 20% of hospitals reported vacancy rates of more than 20%
for imaging professionals. UCSF also stated that California was
experiencing particularly severe shortages of diagnostic imaging
workers. In 1998, the state ranked 49th in per-capita
employment of radiologic technicians, and 43rd in employment of
nuclear medicine technologists. According to the Employment
Development Department, jobs for RTs and RT technicians are
expected to increase by 21%, or 3,400 jobs, between 2008 and
2018.
ARRT is a national certification organization that develops and
administers standards to assess the qualifications of
individuals in medical imaging and radiation therapy. It was
founded in 1922 and registers individuals as RTs in 15
disciplines. A number of state licensing laws, including those
in California, rely on ARRT examination scores for the issuance
of state licenses. In addition to certifying 300,000
technologists nationwide, ARRT certifies more than 31,200 RTs in
AB 352
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California.
ARRT started certifying RAs after a consensus document was
produced in 2002 detailing educational preparation, roles and
responsibilities, levels of supervision, regulatory issues and
certification standards. Currently, there are 12 RA educational
programs in the country that have received ARRT certification,
including one in California at Loma Linda University. According
to the author, RAs are licensed in 29 other states.
The RA title protection established by this bill is intended to
allow RAs to act as a physician extender much like a physician
assistant, providing relief for radiologists and a professional
path for RTs who wish to advance their skills and practice. RAs
would be required to practice under the direct supervision of a
physician and surgeon, and would be allowed to supervise RTs in
the performance of medical imaging procedures using fluoroscopy.
Support . According to the California Radiological Society, "Our
members, who are beginning to bring RAs in to their practices,
often in the hospital setting, have encountered issues since the
category is not now recognized in state law. This interferes
with the ability of RAs to be recognized in the hospital
credentialing process. It has also raised issues with some
malpractice liability carriers who will not provide coverage for
the broader scope of duties for an RA since they are not so
recognized in statute or regulation as having broader training
then (sic) a radiologic technologist."
Opposition . The California Nurses Association states, "CNA
questions the necessity of creating a new licensure category for
RAs, and is concerned that the introduction of a new type of
practitioner will lead to a more fragmented system of care for
radiology patients.
"As an organization, we advocate for the highest standards of
care for patients, and have strong concerns with any measure
that aims to establish new licensure categories for healing arts
practitioners. By establishing licensure for RAs, including a
new scope of practice, this bill would introduce an additional
practitioner to provide care to the patient, thereby further
fragmenting the continuum of care. Further, some have asserted
that this bill may provide a career-ladder for RTs. However,
because the bill would require an RA to also be an RT, this bill
would potentially undermine the employability of RTs who do not
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wish to go on to become an RA because there would be little
incentive to employ both at the same time."
Previous legislation.
AB 623 (Lieu) of 2007 requires DPH to develop a certification
process for RAs. This bill was held in Assembly Appropriations
Committee.
SB 700 (Aanestad) of 2005 provides for the certification of RAs
by DPH. This bill was held in Senate Business, Professions and
Economic Development Committee.
REGISTERED SUPPORT / OPPOSITION :
Support
American Society of Radiologic Technologists (sponsor)
Radiology Practitioner Assistant Society (sponsor)
American Registry of Radiologic Technologists (ARRT)
California Radiological Society
California Society of Radiologic Technologists (CSRT)
Loma Linda University
Numerous individuals
Opposition
California Nurses Association (CNA)
Analysis Prepared by : Angela Mapp / B.,P. & C.P. / (916)
319-3301