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.