BILL ANALYSIS
C.S.H.B. 1200
By: Rodriguez
03-23-95
Committee Report (Substituted)
BACKGROUND
The Texas State Board of Medical Examiners, the Texas State
Podiatry Examiners, the Texas State Board of Nurse Examiners, the
Texas State Board of Dental Examiners, and the Texas Board of
Chiropractic Examiners are required by Section 2.08 of the Medical
Radiologic Certification Act (Article 4512m, Vernon's Texas Civil
Statutes) to adopt rules that must, among other things, "identify
radiologic procedures that are more dangerous or hazardous and may
only be performed by a practitioner or by a medical radiologic
technologist certified under this Act." To date, however, only the
Board of Dental Examiners has identified these procedures for
dental radiologic technicians.
Presently, the Texas Department of Health (TDH) has two
certification categories for radiologic technicians — limited and
general. A limited certification allows radiologic technicians to
work under the supervision of a practitioner if the radiologic
technician has met the TDH's minimum standard educational
requirement of 120 hours of theory and classroom instruction. A
majority of the individuals who handle radiologic procedures
circumvent the TDH's educational requirement of 120 hours by
registering under the name of the practitioner with the respective
Board that licenses the practitioner.
The TDH Radiation Control Bureau makes on-site visits to ensure the
safety of the public. Any licensing violations are sent to the
TDH's Professional Licensing and Certification Division. TDH has
had a difficult time in being effective in dealing with complaints
of violations of the licensing requirements of radiologic
technicians because the law does not give the department injunctive
powers.
It is the responsibility of TDH to certify and penalize individuals
who are in the profession of handling radiologic procedures that
are dangerous and hazardous. However, the TDH is in need of clear
and defined guidelines for disciplinary action.
PURPOSE
This legislation would amend existing law in five areas. It would:
1. Define "direct supervision" and "education program" as
they relate to students.
2. Require "minimum standards" of 120 hours of theory or
classroom instruction as now in TDH rules for all other
persons (other than practitioners) who do radiologic
procedures with the exception of podiatrists, who must
have at least 60 hours of basic theory instruction.
3. Outline violations for students and non-students.
4. Require the TDH to identify radiologic procedures that
are dangerous or hazardous and may only be performed by
a practitioner or medical radiological technologist as
certified under this Act.
5. Give the Texas Department of Health "injunctive relief."
RULEMAKING AUTHORITY
It is the committee's opinion that this bill grants additional
rulemaking authority to the Texas Board of Health in Section 2
[Section 2.05(a)(4), Medical Radiologic Technologist Certification
Act (Article 4512m, V.T.C.S.)] and Section 8 of the Act, and to the
agencies subject to this Act, except the Texas State Board of Nurse
Examiners, in Section 4 (Section 2.08(b), Medical Radiologic
Technologist Certification Act).
SECTION BY SECTION ANALYSIS
SECTION 1. Amends Section 2.03 of the Medical Radiologic
Technologist Certification Act (Article 4512m, V.T.C.S.) by adding
Subdivisions (13), (14), (15) and (16), which provide definitions
for "direct supervision," "education program," "authorized person,"
and "registrant."
SECTION 2. Amends Section 2.05 of the Medical Radiologic
Technologist Certification Act (Article 4512m, V.T.C.S.) by
amending Subsection (a) and adding Subsections (f), (g), (h), (i),
and (j), as follows:
(a) Specifies that registered nurses and physicians'
assistants are among the individuals for whom the Texas Board
of Health (TBH) must set minimum curricula and education
program standards, and clarifies that programs required for
training are "education" programs. Also adds the stipulation
that the TBH must establish, by rule, a registry of persons
required to comply with Section 2.05(f) of this Act.
(f) Provides that the minimum standards of the TBH for
approval of curricula and education programs under Subsection
(a) of this section shall include mandatory training
guidelines for a person, other than a practitioner, or a
medical radiologic technologist, who intentionally administers
radiation to another person for medical purposes, including a
person who does not hold a certificate issued under this Act
who is performing radiologic procedure under the direction of
a practitioner, other than a dentist, or at a hospital. The
training program approved by the Texas Board of Health must
contain the appropriate number of hours of education that must
be completed before the person may perform a radiologic
procedure.
(g) Requires the TBH, with the assistance of other appropriate
state agencies, to identify radiologic procedures that are
dangerous or hazardous and that may only be performed by a
practitioner or a medical radiologic technologist certified
under this Act.
(h) States that Subsection (g) of this section does not apply
to a radiologic procedure involving a dental X-ray machine,
including a panarex or other equipment designed and
manufactured only for use in dental radiography.
(i) Gives TDH the authority to grant an exemption from
requirements of Subsection (f) to a hospital, federally
qualified health center as defined by 42 USC 1396 (d), or
practitioner based upon hardship. These entities may apply to
the Texas Department of Health for an exemption from the
requirements of Subsection (f) of this Section, which shall be
granted if the applicant can show a hardship in employing a
person certified under this Act or trained under Subsection
(f) of this Section. Stipulates what qualifies as a hardship.
(j) Allows the TDH to take into account, when adopting rules
under Subsection (g), whether the radiologic procedure will be
performed by a registered nurse or a physician assistant
licensed under Article 4495b-1, V.T.C.S.
SECTION 3. Amends Section 2.07 of the Medical Radiologic
Technologist Certification Act (Article 4512m, V.T.C.S.) by
amending Subsection (d) and adding Subsection (g), as follows:
(d) Allows a person to perform radiologic procedures without
a certificate issued under this Act if that person performs
the procedure in a hospital that participates in the federal
Medicare program or that is accredited by the Joint Commission
on Accreditation of Hospitals and has completed a training
program approved by the TBH under Section 2.05 of this Act.
(g) States that a person is not required to hold a certificate
issued under this Act to perform a radiologic procedure if
that procedure is performed under the supervision of a
dentist, the person is registered with the State Board of
Dental Examiners, and the person is in compliance with rules
adopted by that board under Section 2.08 of this Act.
SECTION 4. Amends Sections 2.08(b) and (c) of the Medical
Radiologic Technologist Certification Act (Article 4512m,
V.T.C.S.), as follows:
(b) Requires each agency subject to the Act, other than the
Board of Nurse Examiners, to adopt rules in accordance with
Chapter 2001, Government Code, to regulate the manner in which
a licensee of the agency may order, instruct, or direct
another authorized person in the performance of radiologic
procedures. Adds the provision that rules adopted under this
subsection shall allow a practitioner the right to delegate
certain designated diagnostic radiologic procedures to a
person not certified under this Act if the delegation is
allowed by the regulatory board that licenses the
practitioner.
(c) Is amended by deleting the language for (4) and (5) and
replacing it with the language from (6), which requires that
rules adopted under this section establish standards, in
addition to those required by this Act, for the training and
supervision of the operators of the equipment.
SECTION 5. Amends Section 2.11 of the Medical Radiologic
Technologist Certification Act (Article 4512m, V.T.C.S.).
Subsection (a) expands the list of possible disciplinary actions
the TDH can take when someone violates any provisions of this Act
or rules adopted under it. Subsection (b) is amended to reference
Chapter 2001, Government Code, in regard to procedures for taking
disciplinary action and appealing that action. Subsection (c) is
added, outlining causes for which the TDH may take disciplinary
action against a person subject to this Act, other than a
registrant (as defined in Section 1(16) of this bill).
SECTION 6. Amends Section 2.13(a) of the Medical Radiologic
Technologist Certification Act (Article 4512m, V.T.C.S.) to list in
detail possible offenses under this Act.
SECTION 7. Amends Section 2.14 of the Medical Radiologic
Technologist Certification Act (Article 4512m, V.T.C.S.) to allow
the TBH or the TDH to bring civil action to obtain injunctive
relief and recover a civil penalty of up to $1,000 for each day
that a person violates this Act. Also requires the attorney
general, at the request of the TBH or TDH, to bring action in the
name of the state for injunctive relief and/or recover a civil
penalty. Deletes existing expired text concerning the establishment
of the Medical Radiologic Technologist Advisory Board.
SECTION 8. Requires the Texas Board of Health to adopt rules as
indicated in this Act by no later than January 1, 1996.
Additionally, persons subject to the education requirements of this
Act, must complete the requirements by January 1, 1998, but may
continue to perform radiologic procedures authorized by the Medical
Radiologic Technologists Certification Act (Article 4512m,
V.T.C.S.) until that date. The former law is continued in effect
for that purpose.
SECTION 9. Effective date: September 1, 1995.
SECTION 10. Emergency clause.
COMPARISON OF ORIGINAL TO SUBSTITUTE
SECTION 1 of the original bill is amended by the substitute to
include Subdivision (15) and (16) which provide definitions for
"authorized person" and "registrant."
SECTION 2 of the original is amended by the substitute as follows:
(a) now includes that the Texas Board of Health will also be
responsible for adopting rules establishing minimum standards for
education programs to also train registered nurses and physician
assistants to perform radiologic procedures. The Board also is
required to adopt rules establishing minimum standards for approval
of instructors to teach approved curricula or education programs.
Finally, the Board is required to adopt rules establishing a
registry of persons required to comply with Section 2.05 (f) of
this Act.
(h) was added and prescribes that Subsection (g) of this section
does not apply to a radiologic procedure involving a dental X-ray
machine, including a panarex or other equipment designed and
manufactured only for use in dental radiography.
(i) was added and gives TDH authority to grant an exemption from
the requirements of Subsection (f) — regarding training and
education — to a hospital, federally qualified health center, or
practitioner if the entity can show hardship in employing a person
certified under this Act or trained under Subsection (f).
(j) was added and prescribes that in adopting rules under
Subsection (g), the TDH may take into account whether the
radiologic procedure will be performed by a registered nurse or a
physician assistant licensed under Article 4495b-1, Vernon's Texas
Civil Statues.
SECTION 3 of the original is amended by the substitute, which
instead of amending Subsection (e) and adding Subsection (g),
amends (d) and adds (g), as follows:
(d) now allows a person to perform radiologic procedures in a
hospital as long as that hospital participates in the federal
Medicare program or that it is accredited by the Joint Commission
on Accreditation of Hospitals and if that person has completed a
training program approved by the Texas Board of Health, as
prescribed by this Act.
(g) now provides that a person is not required to hold a
certificate issued under this Act to perform a radiologic procedure
if that procedure is performed under the supervision of a dentist;
the person is registered with the State Board of Dental Examiners
and is in compliance with rules adopted by that Board under Section
2.08 of this Act.
SECTION 4 of the original is amended by the substitute as follows:
(b) now includes that rules adopted under this section shall allow
as practitioner the right to delegate certain designated diagnostic
radiologic procedures to a person not certified under this Act if
the delegation is allowed by the regulatory board that licenses the
practitioner.
The remaining sections of the substitute bill are unamended from
the original bill.
SUMMARY OF COMMITTEE ACTION
H.B. 1200 was considered by the committee in public hearing on
March 14, 1995. The committee considered a complete substitute to
H.B. 1200. The substitute was adopted without objection.
The following persons testified in favor of the bill:
Cheryl A. Timm, R.T.(R), M.S., representing self and Texas Society
of Radiologic Technology.
Linda Cluff, representing self and Texas Society of Radiologic
Technology.
Carolyn Nicholas, RTR CM, representing self and Texas Society of
Radiologic Technology.
Marilyn Sackett, R.T. M.Ed., representing self and Advanced Health
Education Center.
David Sack, representing self.
D. Clifford Burross, M.D., representing self and Texas Medical
Association and Texas Academy
of Family Physicians.
Frank Collazo, Jr., representing Texas Society of Radiologic
Technologists.
The following persons testifies against H.B. 1200:
Matthew T. Wall, representing Texas Hospital Association.
James Willman, representing Texas Nurses Association.
H.B. 1200 was left pending in committee on March 14, 1995.
The committee considered H.B. 1200 in a formal meeting on March 23,
1995. The committee considered a complete substitute to H.B. 1200.
The substitute was adopted without objection. The bill was reported
favorably as substituted, with the recommendation that it do pass
and be printed, by a record vote of 7 Ayes, 0 Nays, 0 PNV, 2
Absent.