BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 1199
AUTHOR: Dutton
INTRODUCED: February 22, 2012
HEARING DATE: April 11, 2012
CONSULTANT: Moreno
SUBJECT : Radiologic technologists.
SUMMARY : Permits a radiologic technologist (RT), in
administering contrast materials, to use any chemical solutions
or equipment in accordance with the hospital or imaging center
protocol and that is found to be an acceptable practice by the
American College of Radiology (ACR) or other nationally
recognized accreditation society. Permits supervised
venipunctures on humans or phantom extremity to be counted
towards the 10 venipunctures required to deem a RT sufficiently
trained.
Existing law:
1.Defines "radiologic technologist" as any person, other than a
licentiate of the healing arts, making application of X-rays
to human beings for diagnostic or therapeutic purposes, as
specified.
2.Permits certified RTs with sufficient education and training
to perform venipuncture in an upper extremity and to
administer contrast materials under the general supervision of
a licensed physician.
3.Deems training and education to sufficient if the RT has,
among other things, performed 10 venipunctures under
supervision.
This bill:
1.Permits RTs, in administering contrast materials in order to
ensure the security and integrity of the intravenous cannula,
to use any chemical solutions or equipment in accordance with
the hospital or imaging center protocol and that is found to
be an acceptable practice by the ACR or other nationally
recognized accreditation society.
2.Permits supervised venipunctures on humans or phantom
extremity to be counted toward the 10 venipunctures required
Continued---
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to deem a RT sufficiently trained.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1.Author's statement. According to the author, the Radiologic
Health Branch (RHB) within the Department of Public Health
(DPH) has recently stated that although the law does not
specify how practice venipuncture should be performed, the
practice should occur on a human being. However, doing so has
become increasingly difficult due to concerns over liability
and availability of volunteers. By allowing the RT to conduct
practice venipunctures on a phantom simulator, it would
decrease the need for human volunteers while still ensuring
that RTs obtain sufficient practice.
2.Background. According to the website of Ca�ada College in
Redwood City (which has a DPH-approved RT school), a RT is a
health care professional who performs diagnostic imaging
examinations with the use of X-rays, working directly with
patients and physicians. RTs are educated in patient care,
radiation safety, radiation protection, image and film
processing, anatomy, physiology, patient positioning and
examination techniques. RTs often specialize in a particular
diagnostic imaging area, such as computed tomography magnetic
resonance, mammography, bone densitometry,
cardiovascular-interventional and general radiography. As of
October 4, 2010-the date of the most recent list of schools
that provide RT training that DPH has, there are 35 diagnostic
RT schools, 6 therapeutic RT schools, 34 RT fluoroscopy permit
schools, and 13 limited permit schools in California.
3.Injecting contrast materials. The ACR Practice Guideline for
the Use of Intravascular Contrast Media states that the health
care professional performing the injection may be a certified
and/or licensed RT, nurse, physician assistant, physician, or
other appropriately credentialed health care professional
under the direct supervision of a radiologist or his or her
physician designee, if the practice is in compliance with
institutional and state regulations. Training and proficiency
in cardiopulmonary resuscitation are recommended for those who
attend to patients undergoing contrast-enhanced examinations.
4.DPH notices. In December 2010, DPH sent a notice to all
California-approved radiologic technology and therapy schools
stating that, based on legislative intent and enacted law, the
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RHB determined that the 10 venipunctures required to be
considered sufficiently trained must be performed on a human
being. The notice further stated that the required
venipunctures are to be made under supervision, which infers
harm to a human being. DPH stated that puncture techniques may
be practiced on a mannequin but the required 10 venipunctures
must be performed on a human being. In March 2011, DPH again
issued a notice to provide clarification regarding existing
statute related to the training required to legally perform
venipuncture. DPH required RT schools to provide their
venipuncture curriculum to document that the statutory
training and education requirements in existing law were being
met. Any school that does not meet the education and training
requirements for venipuncture is required to incorporate the
instruction into their curriculum by January 1, 2013.
5.American Registry of Radiologic Technologists standards. The
2012 American Registry of Radiologic Technologists (AART)
certification handbook outlines clinical competency
requirements for radiography. With regard to "general patient
care," the requirements lay out six patient care activities in
which RTs must demonstrate clinical competency, including
venipuncture. The handbook states that "the activities should
be performed on patients; however, simulation is acceptable if
the state or institutional regulations prohibit candidates
from performing the procedure on patients." The handbook goes
on to further state:
The ARRT requirements specify that certain clinical
procedures may be simulated. Simulations must meet the
following criteria: (a) the student is required to
competently demonstrate skills as similar as
circumstances permit to the cognitive, psychomotor,
and affective skills required in the clinical setting;
(b) the program director is confident that the skills
required to competently perform the simulated task
will generalize or transfer to the clinical setting,
and, if applicable, the student will evaluate related
images, positioning a fellow student for a projection
without actually activating the x-ray beam, and
performing venipuncture by demonstrating aseptic
technique on another person, but then inserting the
needle into an artificial forearm or grapefruit.
6.Other professions. RHB performed a limited survey of training
programs for phlebotomy, registered and vocational nursing,
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physicians, and physician assistants in March 2011. All
contacts indicated that simulator phantoms or mannequins are
used for familiarizing trainees with equipment use, aseptic
techniques, inserting needles, and finding veins. However,
all contacts stated that completion of training occurred only
after competently performing a number of venipunctures on live
persons. The number of required venipunctures ranged from 20
to over 200.
7.RT programs and venipuncture training. A number of directors
of RT programs wrote to Committee staff to express concerns
over their ability to comply with the training requirements
related to venipuncture in current law. Specifically, school
staff state that it is very difficult for students to perform
venipuncture because many clinical sites where RTs receive
training do not permit students to needle stick patients.
These school staff indicate that the schools themselves do not
have the capacity to have students perform venipuncture and it
is a struggle to coordinate between sites to get students the
required venipuncture experience.
8.Support. The sponsor of this bill, the California
Radiological Society (CRS), states that the ability of
students to perform venipunctures on human volunteers has been
increasingly difficult due to concerns over liability and
availability of volunteers. CRS states that unless the current
law is modified to allow the use of simulator phantoms, many
schools have indicated that their ability to train RTs will be
impaired. In addition, CRS writes that it is necessary for RTs
to be allowed to inject materials that are approved by the
ACR, other than the actual contrast materials. An example of
this would be the use of saline, which in some cases can
support the patency of the cannula or port for injection. The
Merced College Diagnostic Radiologic Technology Program writes
that it is especially disconcerting that RT schools have until
the end of this year to be in compliance with existing law as
there is no way they can abide by how it reads. The Merced
College Diagnostic Radiologic Technology Program further
states that, while it is not the standard of practice in all
radiology settings, the radiology community would like the
statute to allow RTs to inject other substances related to a
contrast injection.
9.Policy comments.
a. This bill expands the types of materials that can be
administered intravenously when RTs are administering
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contrast materials that are found to be acceptable by ACR
or other nationally recognized accreditation society.
However, it does not appear that ACR has set any standard.
It is unclear, then, what will be the practical impact of
this provision.
b. AART guidelines on venipunctures state that simulation
should only be used if state law prohibits performing
venipunctures on humans, which California statute does not
do. Additionally, other professions that perform
venipuncture, such as phlebotomists, must perform the
training venipunctures on human beings. By permitting
training venipunctures to be performed on something other
than humans, this bill appears to go against national
guidelines and is not in line with training standards for
other professionals that perform venipunctures. The
Committee may wish to consider if it wishes to permit
someone to be certified as a RT and perform venipuncture
without ever having been required to perform it on a human
subject. If so, this bill should define the term "phantom
extremity" or use a term that is already defined in
statute.
c. RT training programs have provided comments to the
Committee indicating that in many cases, RTs do not perform
venipuncture in their places of practice once they are
certified. If this is the case, and it is becoming
increasingly difficult to meet the venipuncture training
requirements in existing law, the Committee may wish to
consider whether it continues to make sense to have
venipuncture remain part of their certification
requirement. An alternative could be to have a separate
certification, whether as part of their initial
certification training program or while supervised in a
practice setting, for those RTs who will be performing
venipuncture as part of their practice.
SUPPORT AND OPPOSITION :
Support: California Radiological Society (sponsor)
California Medical Association
Merced College Diagnostic Radiologic Technology
Program
Four individuals
Oppose: None received.
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