SRC-CDH C.S.S.B. 943 75(R)BILL ANALYSIS


Senate Research CenterC.S.S.B. 943
By: Nelson
Health & Human Services
4-25-97
Committee Report (Substituted)


DIGEST 

The 74th Legislature expanded the power of the Texas Board of Health
(TBH), upon recommendation from the Medical Radiological Technologist
(MRT) Advisory Committee, by giving it statutory authority over all
personnel, including registered nurses and physician assistants, who
perform radiologic procedures; and granting it the authority to determine
dangerous procedures. In addition, the MRT Advisory Committee was given
the authority to mandate training requirements for these personnel and to
determine what procedures these personnel may or may not perform. During
the interim, TBH rejected rules from the MRT Advisory Committee that would
have limited access to necessary radiologic procedures while also raising
the cost for such procedures.  The MRT Advisory Committee was asked by TBH
to develop consensus rules; however, the committee again recommended
proposed rules that limited access to care and raised costs.   

This legislation would shift the authority to identify dangerous and
hazardous radiologic procedures and regulate the radiologic procedures
which a registered nurse or a licensed physician assistant may perform
from TBH to the respective licensing boards of health care providers
supervising and providing radiologic procedures, including the Texas State
Board of Medical Examiners, the Texas Board of Chiropractic Examiners, and
the Texas State Board of Podiatric Medical Examiners. C.S.S.B. 943 also
requires these entities to adopt standards for mandatory training
guidelines for certain persons who administer radiation for medical
purposes under a physician's direction. 

PURPOSE

As proposed, C.S.S.B. 943 provides for the regulation of medical
radiologic technologists and other persons who perform radiologic
procedures. 

RULEMAKING AUTHORITY

Rulemaking authority is granted to the Texas State Board of Medical
Examiners in SECTION 3 (Sections 5.04(b) and 5.045(b), Subchapter E,
Article 4495b, V.T.C.S.); to the Texas Board of Chiropractic Examiners in
SECTION 5 (Sections 13c(b) and 13d(b), Article 4512b, V.T.C.S.); and to
the Texas State Board of Podiatric Medical Examiners in SECTION 6
(Articles 4577(b) and 4578(b), V.T.C.S.) of this bill. 

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Section 2.03, Article 4512m, V.T.C.S. (Medical
Radiologic Technologist Certification Act), by adding Subdivision (17), to
define "physician assistant." 

SECTION 2. Amends Section 2.05, Article 4512m, V.T.C.S., to authorize the
Texas Board of Health (TBH), when adopting minimum standards for
certifying medical radiologic technologists, to establish criteria for
issuing certificates to a person licensed by the Nuclear Medicine
Technologist Certification Board, rather than the American Registry of
Clinical Radiography Technologists. Provides that this subsection does not
apply to a person who administers radiation to another person for medical
purposes if the person, before September 1, 1998, had at least one year of
experience in performing radiologic procedures under the direction,
supervision, and authority of a practitioner. Deletes the provisions
requiring TBH, by rule, with the assistance of other appropriate state
agencies, to identify dangerous radiologic procedures that may only be
performed by certain technologists. Requires the Texas Department of
Health (TDH) to exempt certain applicants, including a rural  health
clinic, from the requirements of Subsection (f) if the applicant shows a
hardship in employing a person certified under this Act or trained as
required by Subsection (f).  Sets forth the persons exempt from the
requirements and guidelines adopted under various provisions of this
section. Makes conforming changes.  

SECTION 3. Amends Subchapter E, Article 4495b, V.T.C.S., by adding
Sections 5.04 and 5.045, as follows: 

Sec. 5.04.  DANGEROUS OR HAZARDOUS RADIOLOGIC PROCEDURES.  Defines
"radiologic procedure."  Requires the Texas State Board of Medical
Examiners (TBME), with the advice of TDH and other appropriate state
agencies, by rule, to identify radiologic procedures that are dangerous or
hazardous and that may only be performed by a physician or certified
medical radiologic technologist.  Provides that this section does not
apply to certain radiologic procedures.  Requires the TBME, in adopting
rules, to consider whether the radiologic procedure will be performed by a
registered nurse or a licensed physician assistant.   

Sec. 5.045.  TRAINING GUIDELINES FOR RADIOLOGIC PROCEDURES.  Defines
"radiologic procedure."  Sets forth the terms by which TBME is required to
adopt minimum standards for mandatory training guidelines for a person,
other than a physician or a medical radiologic technologist, who
intentionally administers radiation to another person for medical purposes
under the direction, supervision, and authority of a physician.
Establishes the persons exempt from the requirements of this section.
Authorizes TBME to establish and collect fees necessary to recover the
costs of administering this section.   

SECTION 4. Amends Section 13a(a), Article 4512b, V.T.C.S., to make a
conforming change. 

SECTION 5. Amends Article 4512b, V.T.C.S., by adding Sections 13c and 13d,
as follows: 

Sec. 13c.  DANGEROUS OR HAZARDOUS RADIOLOGIC PROCEDURES.  Defines
"radiologic procedure."  Requires the Texas Board of Chiropractic
Examiners (TBCE), with the advice of TDH and other appropriate state
agencies, by rule, to identify radiologic procedures that are dangerous or
hazardous and that may only be performed by a chiropractor or certified
medical radiologic technologist.  Requires the provisions of Section 5.04,
Article 4495b, V.T.C.S., to apply in lieu of this section when the
procedure is performed in a hospital.  

Sec. 13d.  TRAINING GUIDELINES FOR RADIOLOGIC PROCEDURES.  Defines
"radiologic procedure."  Requires TBCE to adopt minimum standards for
mandatory training guidelines for certain persons who intentionally
administer radiation under the direction of a chiropractor.  Requires the
guidelines to permit a person to comply with the guidelines by completing
a course of instruction under a chiropractor who employs or supervises the
person and by passing a written examination.  Sets forth the persons who
are exempt from this section.  Authorizes TBCE to establish and collect
fees necessary to recover the costs of administering this section. 

SECTION 6. Amends Chapter 11, Title 71, V.T.C.S., by adding Articles 4577
and 4578, as follows: 

Art. 4577.  DANGEROUS OR HAZARDOUS RADIOLOGIC PROCEDURES.  Defines
"radiologic procedure."  Requires the Texas State Board of Podiatric
Medical Examiners (TBPME), with the advice of TDH and other appropriate
state agencies, by rule, to identify radiologic procedures that are
dangerous or hazardous and that may only be performed by a podiatrist or a
certified medical radiologic technologist.  Requires the provisions of
Section 5.04, Article 4495b, V.T.C.S., to apply in lieu of this article
when the procedure is performed in a hospital.  

Art. 4578.  TRAINING GUIDELINES FOR RADIOLOGIC PROCEDURES.  Defines
"radiologic procedure."  Requires TBPME to adopt minimum standards for
mandatory  training guidelines for certain persons who intentionally
administer radiation under the direction of a podiatrist.  Requires the
guidelines to permit a person to comply by completing a course of
instruction under a podiatrist who employs or supervises the person and by
passing a written examination.  Establishes the persons exempt from the
requirements of this article.  Authorizes TBPME to establish and collect
fees necessary to recover the costs of administering this article. 

SECTION 7. (a)  Effective date:  September 1, 1997.
 
(b)  Provides that rules adopted before the effective date of this Act by
TBH under Section 2.05(f), Article 4512m, V.T.C.S., remain in effect after
the effective date of this Act except to the extent the rules conflict
with a provision of this Act.   

(c)  Requires TBME to adopt rules under Section 5.04, Article 4495b,
V.T.C.S., not later than January 1, 1998.  Requires TBCE to adopt rules
under Section 13c, Article 4512b, V.T.C.S., not later than January 1,
1998.  Requires TBPME to adopt rules under Article 4577, V.T.C.S., not
later than January 1, 1998. 

(d)  Requires TBME to adopt mandatory training guidelines under Section
5.045, Article 4495b, V.T.C.S., not later than June 1, 1998.  Requires a
person to complete the training under the guidelines not later than a
certain date.     
       
(e)  Requires TBCE to adopt mandatory training guidelines under Section
13d, Article 4512b, V.T.C.S., not later than June 1, 1998.  Requires a
person to complete the training under the guidelines not later than a
certain date.   

(f)  Requires TBPME to adopt mandatory training guidelines under Article
4578, V.T.C.S., not later than June 1, 1998.  Requires a person to
complete the training under the guidelines not later than a certain date.  

SECTION 8. Emergency clause.  

SUMMARY OF COMMITTEE CHANGES

Deletes former SECTION 2.

SECTION 2.

Amends Section 2.05, Article 4512m, V.T.C.S., to authorize TBH to
establish criteria for issuing a certificate to a person licensed by the
Nuclear Medicine Technologist Certification Board, rather than the
American Registry of Radiologic Technologists.  Reinstates the provision
establishing that this section does not apply to certain radiologic
procedures. Requires TDH to exempt a rural health clinic from the
requirements of Subsection (f) under certain circumstances.  Establishes
the persons exempt from the requirements of various provisions of this
section.   

SECTION 3. 

Amends Section 5.04, Article 4495b, V.T.C.S., to delete the definition of
"practitioner" and remove all references to practitioner.  Requires TBH,
with the advice, rather than assistance, of various state agencies, to
identify dangerous radiologic procedures.   

Amends Section 5.05, Article 4495b, V.T.C.S., to change the terms under
which certain persons are exempt from complying with the requirements of
this section. 

SECTION 5.

Amends Article 4512b, V.T.C.S., to add Sections 13c and 13d, to establish
provisions regarding dangerous radiologic procedures and training
guidelines relating to chiropractors. 
 
SECTION 6.

Amends Chapter 11, Title 71, V.T.C.S., to establish provisions regarding
dangerous radiologic procedures and training guidelines relating to
podiatrists.   

Deletes former SECTION 5.

SECTION 7.

Amends the provisions regarding the adoption of rules and mandatory
training guidelines under this Act.