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ARIZONA STATE LEGISLATURE
Forty-eighth Legislature – First Regular Session
SENATE HEALTH AND HOUSE HEALTH
COMMITTEE OF REFERENCE
Minutes of Interim Meeting
Senate Hearing Room 1 – 9:30 a.m.
Chairman O’Halleran called the meeting to order at 9:32 a.m. and attendance was noted by the secretary.
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Senator Tom O'Halleran, Co-Chair |
Representative Bob Stump, Co-Chair |
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Senator Amanda Aguirre |
Representative Nancy Barto |
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Senator Barbara Leff |
Representative David Bradley |
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Senator Thayer Verschoor |
Representative Linda Lopez |
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Representative Rick Murphy |
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Senator Paula Aboud |
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Kim Hildebrand, Performance Audit Manager, Office of the Auditor General
Todd Rowe, Board of Homeopathic Medical Examiners
Christine Springer, Board of Homeopathic Medical Examiners
Jerry Weinsheink, representing himself
Marianne Cherney, representing herself
Neil Garfield, Association for Public Access to Medicine
Barney Nugent, representing himself
Linda Heming, CHOICE
Iris Bell, Doctor, Arizona Homeopathic and Integrative Medical Association
Cliff Heinrich, Doctor, representing himself
Kathleen Fry, Doctor, representing herself
Denise Nugent, representing herself
Lee Bakunin, Attorney, representing herself
Bruce Shelton, Doctor, Arizona Homeopathic and Integrative Medical Association
Amanya Jacobs, Director of Evolution of Self School of Homeopathy
Cindy Zukerman, representing herself
Shelly Malone, representing herself
Stan Klusky, representing himself
Gladys Conroy, representing herself
Joan Reynolds, Regulatory Board of Physician Assistants
Debra Rinaudo, Board of Behavioral Health Examiners
Stuart Goodman, Board of Behavioral Health Examiners
Bev Hermon, BH Consulting
Richard Poppy, Therapeutic Practitioners Alliance of Arizona (The Alliance)
Rachael Hopkins, representing herself
Ronald Anton, representing himself
Josephine Sbrocca, representing herself
Cedric Davis, Board of Behavioral Health Examiners
Della Estrada, Arizona Acupuncture Board of Examiners
Kathryn Babits, Arizona State Board of Occupational Therapy Examiners
Eugene Smith, Arizona Alliance of Non-Physician Surgical Assistants
Susie Cannata, Arizona Alliance of Non-Physician Surgical Assistants
Rory Hays, Arizona Nurses' Association
Scott Leckie, Radiology Practitioner Assistants
Jane Van Valkenburg, Certification Board for Radiology Practitioner Assistants (CBRPA)
Mary Connell, M.D., representing herself
Christine Lung, American Society of Radiologic Technologists (ASRT)
John Gray, Grand Canyon University
Joyce Geyser, Arizona Radiological Society
James Abraham, National Society of Radiology Practitioner Assistants
Heather Owens, Senate Health Analyst
Aubrey Godwin, Medical Radiologic Technology Board of Examiners (MRTBE)
Teresa Rodgers, Behavioral Health Coalition of Southern Arizona
David Giles, Behavioral Health Coalition of Southern Arizona
Holly Baumann, Southwest Autism Research and Resource Center
John MacDonald, Arizona Dental Association (ADA)
Rick Murray, Arizona Dental Association
Anita Elliott, Arizona Dental Association
Nicole Laslavic, Arizona State Dental Hygienists' Association
Janet Midkiff, Arizona State Dental Hygienists' Association
Nicole Albo, Arizona Dental Assistants’ Association
Alisa Feugate, Arizona Dental Hygienists' Association
Opening Remarks
Chairman O’Halleran welcomed everyone and requested that the speakers keep their comments as brief as possible, as the committee members are well-versed in the issues to be discussed today.
Sunset Review of the Board of Homeopathic Medical Examiners
Presentation by Auditor General
Kim Hildebrand, Performance Audit Manager, Office of the Auditor General, gave a presentation on their findings issued in August, 2007 (Attachment 1). She described the history and responsibilities of the Board of Homeopathic Medical Examiners, as well as staff and funding information. She explained the disciplines that make up homeopathic medicine.
Ms. Hildebrand discussed the three findings of the audit:
Senator Verschoor asked if homeopathic physicians, after obtaining their homeopathic license, can allow their MD or DO licenses to lapse; Ms. Hildebrand replied in the affirmative.
Senator Leff asked about separate Boards in other states; Ms. Hildebrand stated that only two other states have separate Homeopathic Boards, as does Arizona.
Senator Leff asked for more information about the felons who have been given homeopathic licenses; Ms. Hildebrand replied that one of the felonies was fraud-related.
Senator Leff asked what has been improved upon since the audit two years ago; Ms. Hildebrand replied that she was only aware of the felony issue. Senator Leff commented that perhaps the follow-up items should be specified more clearly.
Senator Verschoor asked if the licensee must live and practice in Arizona; Ms. Hildebrand replied that they do not have to and that it is not uncommon for physicians to be licensed in several states.
Cochairman Stump asked if the last audit was twenty years ago; Ms. Hildebrand replied that the Legislature makes the determination of interval and who (Auditor or Committee of Reference) performs the audit.
Response by Board of Homeopathic Medical Examiners
Todd Rowe, Board of Homeopathic Medical Examiners, explained that the Legislature requested a performance audit two years ago, that the Board essentially agreed with the recommendations and has moved to implement them. Further, he identified changes that will require statutory action (Attachment 2).
Mr. Rowe explained why the continuance of the Board is important:
1. public safety, wherein medical examiners do not know about homeopathy which uses different methods
2. public demand for choice in health care
3. growth of homeopathic medicine
Mr. Rowe stated that he disagrees with the recommendation to change licensure to limit to specific practices.
Mr. Rowe addressed two allegations:
1. insufficient training for physicians – He stated these allegations are untrue and described the levels of training required for specialty certification.
2. insufficient training for medical assistants – He stated these allegations are untrue, stating that there has never been a complaint against medical assistants, and that their training is consistent with other medical assistant fields (Attachment 3).
Mr. Rowe stated that there is a concern about advertising of medical assistants and stated that the Board will require that assistants cite their homeopathic supervisor in any advertising.
Senator Leff asked if the medical assistants require direct or only indirect supervision; Mr. Rowe replied that the statute does not specify, but that the physician must be on-site. Discussion ensued on this topic of assistants and on the specifics of training and licensing. Mr. Rowe stated that there are state licensing exams and national certification exams for specialty practices.
Senator Verschoor asked what would happen to the fifty practitioners who would be unregulated if the Board goes away; Mr. Rowe replied that 20 percent of their physicians are single-license and would lose that, and there would be 44 medical assistants who would no longer be regulated, and the fifty or more practitioners per year coming out of school would be unregulated.
Christine Springer, Board of Homeopathic Medical Examiners, discussed the statutory changes proposed in Attachment 2. She also addressed the question “Is homeopathy a religion?” (Attachment 4).
Senator Verschoor asked how quickly the Board can implement these changes to modalities and continuing education; Ms. Springer replied that, allowing for a lead-in time, the intent is to do so within the next year.
Senator Verschoor asked how many applications have been denied; Ms. Springer replied two in 2006 and none in 2007.
Ms. Springer addressed funding and processing of complaint procedures which are in need of improvement. She stated that the complaint tracking system has been instituted and that investigation begins immediately, regardless of jurisdiction.
Senator Leff asked if medical assistants take an exam, and how their background is evaluated, and if they are certified. Ms. Springer replied that it is a different model, that they are registered, not licensed, and that they do not take an exam. She stated that any complaints would go against their supervising physician. In addition, she stated that either practical training or 180 hours of training through a school is required.
Senator Verschoor asked about the 2-year felony wait period; Ms. Springer replied that the wait period begins after all requirements of the conviction have been complied with.
Representative Barto asked what the complaint process was; Ms. Springer replied that other physicians are identified and serve as investigators, according to which modality is appropriate, and that the process is in place now.
Public Testimony
Jerry Weinsheink, representing himself, stated his belief that it is time to sunset this Board due to the problems with licensing and improper training.
Marianne Cherney, representing herself, distributed information (Attachment 5) showing the types of therapy regulated by other boards, demonstrating that alternative medicine is just fine without this Board. She stated her opinion that the Board should be sunset.
Neil Garfield, Association for Public Access to Medicine, addressed the committee to represent associations of physicians seeking to provide alternative health care. He stated that more direct supervision by practitioners is indeed required, but that he supports the continuance of the Board.
Barney Nugent, representing himself, stated his concern that this Board has licensed felons and he wishes it to be sunset.
Linda Heming, CHOICE, stated her support for the continuation of this Board and its regulation of alternative medicine physicians. She presented the members with 7,000 signatures favoring continuation.
Senator Leff asked about lay homeopaths, who practice without a license; Mr. Rowe said that legally they cannot practice unless regulated by the Board. Senator Verschoor asked if the Board does license folks who live and practice outside Arizona; Mr. Rowe replied that this is common practice.
Iris Bell, Doctor, Arizona Homeopathic and Integrative Medical Association, stated that she supports continuation of the Board and that the public seeks choices in and uses alternative medicine.
Cliff Heinrich, Doctor, representing himself, stated his opposition to the Board, stating that the loss of lives shows that the safety of the public is not being protected.
Kathleen Fry, Doctor, representing herself , addressed the committee to state that she is in opposition to the Board and wishes it to be sunset due to its failure to protect the public. She distributed a document (Attachment 6) which gives a chronological list of her concerns, and stated that she believes that this Board is not held to the same high standards as other Boards.
Denise Nugent, representing herself, stated her opposition to the Board due to her concern that training is inadequate and that licenses are given to people of questionable ethics and character.
Lee Bakunin, Attorney, representing herself, distributed documents, including the Arizona Medical Board Guidelines (Attachment 7) and a letter expressing concern about the advertising being done by homeopathic medical assistants (Attachment 8).
Bruce Shelton, Doctor, Arizona Homeopathic and Integrative Medical Association, addressed the committee to state his support for continuing the Board, stating that Arizona established this Board 27 years ago and is one of three in the nation. He stated that the audit has been concluded and the Board is in the process of complying.
Senator Leff asked what a lay homeopath is; Dr. Shelton replied that they are associated with unlicensed practitioners and that the Board regulates a legitimate profession. Discussion ensued about licensing, particularly those physicians who come to Arizona from other states, get their homeopathy license here, and then let their previous licenses lapse.
Amanya Jacobs, Director of Evolution of Self School of Homeopathy, addressed the committee to state that she is against the continuance of the Homeopathic Board (Attachment 9).
Cindy Zukerman, representing herself, identified herself as a cancer patient who was saved by a homeopathic physician and she urged the committee to continue the Board.
Shelly Malone, representing herself, stated that her life was saved by a homeopathic physician and she urged the committee to continue the Board.
Stan Klusky, representing himself, identified himself as a proponent of chelating therapy and a supporter of the Board.
Gladys Conroy, representing herself, stated that she cannot take pharmaceutical products and supports homeopathy.
Discussion
Senator Verschoor asked what the review process is at this time; Ms. Hildebrand described a follow-up process which the Board has been very receptive to. She stated that her office would be in there every six months for two years to check on the implementation of the recommendations and that a report would be issued after each six month visit.
Chairman O’Halleran identified two issues to be discussed: the length of time before the next Board review and if the requested statutory changes should be included in the motion.
Senator Verschoor stated that he is uncomfortable going beyond two years. Representative Lopez commented that with the six month review period, perhaps a five year sunset length should be considered. Senator Leff stated that this is not a questioning of the practice of homeopathy but of the Board’s efficiency and a concern with medical assistants acting more like physicians’ assistants.
Recommendations by Committee of Reference
Cochairman Stump moved that the Senate and House Health Committee of Reference recommend the continuation of the Board of Homeopathic Medical Examiners for two years. The motion carried by a voice vote.
Chairman O’Halleran recessed the committee at 11:56 a.m.
Chairman O’Halleran reconvened the committee at 12:07 p.m.; all members were present except Senator Aboud.
Sunset Review of the Regulatory Board of Physician Assistants
Presentation by Regulatory Board of Physician Assistants
Joan Reynolds, Regulatory Board of Physician Assistants, addressed the committee to describe the Board composition, the number of Physician Assistants in Arizona, and the two training programs in Arizona. She stated that the Board exists to protect Arizonans’ health and to monitor, license, and regulate physician assistants.
Recommendations by the Committee of Reference
Cochairman Stump moved that the Senate and House Health Committee of Reference recommend the continuation of the Regulatory Board of Physician Assistants for ten years. The motion carried by a voice vote.
Sunset Review of the Board of Behavioral Health Examiners
Presentation by Board of Behavioral Health Examiners
Debra Rinaudo, Board of Behavioral Health Examiners, addressed the committee to explain that the Board was originally established to offer a system of voluntary certification in four disciplines:
1. marriage and family therapy,
2. professional counseling,
3. social work, and
4. substance abuse counseling.
She stated that the Board is responsible for protecting the public by ensuring that certified professionals met minimum standards in education and training, and investigating and taking action on complaints. In 2003, mandatory licensure of psychotherapy was added to its responsibilities. She stated that grandfathering those with certification into licensed status was allowed.
Since 2004, due to licensure, there has been a dramatic increase in complaints and the Board has a complaints backlog and must triage the complaints in order to address the most serious quickly.
Senator Leff asked what happens to the less serious complaints; Ms. Rinaudo replied that all are investigated, but that those not dealing with client harm are deemed less serious. Ms. Rinaudo added that additional investigators will be hired in FY 2008 which will allow the Board to eliminate the backlog.
Ms. Rinaudo discussed the two-year provisional license granted those who are licensed in other states and who must work under direct supervision before they can obtain a full license. She described the confidential impaired professionals program designed to encourage early self-reporting.
She stated that there are concerns from licensed agencies such as Department of Health Services, which are exempt from licensing by this Board, but in general there is widespread support for provisional licenses.
Cochairman Stump relayed that he has received many constituents’ concerns about the requirement for four supervisors to signoff on supervisory hours and the difficulty meeting this requirement; Ms. Rinaudo explained that training is only required for those seeking independent licensure, that individuals coming straight out of school at the associate level do not require supervision hours.
Cochairman Stump asked about practitioners waiting on complaint resolution; Ms. Rinaudo stated that the Board is aware of the complaints, that it does have a backlog due to the grandfathering in from certification to licensure and a resultant resource problem, and that additional personnel are being added to address this.
Senator Verschoor asked about the grandfathering situation; Ms. Rinaudo replied that certification has been offered by the Board since 1988, but that since July of 2004 licensure is required and anyone with certification would be grandfathered in. Senator Verschoor asked if the rush to do this reflected a change in standards; Ms. Rinaudo replied that the qualifications for substance abuse counseling were much more strenuous for licensure and also that there was a waiver of all of the exams for the grandfathered individuals.
Senator Verschoor asked if now there are licensed individuals with a lower standard of qualifications than newer practitioners; Ms. Rinaudo replied in the affirmative. Senator Verschoor asked if there is an attempt to raise the standards for the grandfathered individuals; Ms. Rinaudo replied that there has been no attempt to do that.
Stuart Goodman, Board of Behavioral Health Examiners, addressed the board to explain the rationale and benefits of grandfathering.
Speaker Verschoor asked the cost of a license and if it might be increased; Ms. Rinaudo replied that the cost is $250 every two years, which reflect 1989 dollars. Discussion ensued about the need for more funding, and increase in the cap, and an increase in fees in order to avoid a decrease in services.
Representative Lopez asked about provisional licenses and what is required to comply in Arizona; Ms. Rinaudo replied that some people can come into Arizona and obtain their licenses, but that some disciplines are standardized across the nation and some are not. She went on to explain that the only restriction with a provisional license is that the practitioner must work under supervision. Representative Lopez asked if Arizona has reciprocity guidelines with other states; Ms. Rinaudo replied that in general states do not have reciprocity between health care boards.
Representative Bradley asked for a remedy for practitioners who do not have their proof of supervision; Ms. Rinaudo replied that their licensure file should contain all the supervision forms. She further stated that the provisional license is always the remedy, to provide the time to fulfill all the requirements.
Public Testimony
Bev Hermon, BH Consulting, addressed the committee to express her concerns about the Board’s operations (Attachment 10). She stated she is against continuance of the Board.
Richard Poppy, Therapeutic Practitioners Alliance of Arizona (The Alliance), expressed his concerns about how licenses are granted, particularly to those who have been practicing for many years (Attachment 11). He stated that his group is working on reciprocity guidelines, supervisory setting requirements, and core course requirements (standardizing semester hours and course hours).
Rachael Hopkins, representing herself, addressed the committee to express her concerns about the Board operations. She described her difficulties with the licensing process, explaining that her application has been held up for one year due to the lack of one credit hour.
Senator Leff asked if she has taken the exam and passed it; Ms. Hopkins replied in the affirmative.
Ronald Anton, representing himself, expressed his concerns about the Board, the lack of reciprocity, and the difficult licensure process. He stated that he may not have moved to Arizona had he known of these difficulties, and that he was reluctant to testify for fear of reprisal.
Josephine Sbrocca, representing herself, stated that she was denied licensure due to one book in one course she took at Prescott College; she did state that “there is life without licensure”.
Cedric Davis, Board of Behavioral Health Examiners, a member of the Board for the past six years, testified in favor of continuance of the Board, stating that the standards were set by stakeholders and are similar to those in other states.
Discussion
Cochairman Stump stated that he is strongly in favor of a performance audit, as the last one was in 1997.
Senator Leff stated that she now has concerns that she did not have before, particularly that a Board should not, under the guise of protecting the public, keep people from working. She feels that if someone has passed the exam, that should qualify them, and they should not be held back by coursework issues about a book or credit hours; she is in favor of a performance audit also.
Chairman O’Halleran stated that, even with a long sunset, if the results of an audit require the Board to be reviewed sooner that can occur; he stated his support for an audit.
Representative Murphy stated that he is in favor of a performance audit, but wondered if the Auditor General can do this in a timely fashion due to their current workload. Discussion ensued about the length of the continuation.
Recommendations by the Committee of Reference
Cochairman Stump moved that the Senate and House Health Committee of Reference recommend the continuation of the Board of Behavioral Health Examiners for five years and that the Joint Legislative Audit Committee consider scheduling a performance audit in due haste.
Senator Leff asked if the committee could reconvene after the audit is completed.
Cochairman Stump withdrew his motion.
Cochairman Stump moved that the Senate and House Health Committee of Reference recommend the continuation of the Board of Behavioral Health Examiners for five years and that the Joint Legislative Audit Committee consider scheduling a performance audit as soon as possible with a legislative committee review at the end of such audit. The motion carried by a voice vote.
Chairman O’Halleran recessed the committee at 1:31 p.m.
Chairman O’Halleran reconvened the committee at 2:11 p.m.; all members were present except Senator Aboud and Senator Aguirre.
Sunset Review of the Acupuncture Board of Examiners
Presentation by Acupuncture Board of Examiners
Della Estrada, Arizona Acupuncture Board of Examiners, explained that the Board provides regulatory oversight of the almost 450 active licensed acupuncturists in Arizona and has successfully accomplished its mandate to ensure the safety of the general public (Attachment 12).
Recommendations by the Committee of Reference
Cochairman Stump moved that the Senate and House Health Committee of Reference recommend the continuation of the Acupuncture Board of Examiners for ten years. The motion carried by a voice vote.
Sunset Review of the Board of Occupational Therapy Examiners
Presentation by Board of Occupational Therapy Examiners
Kathryn Babits, Arizona State Board of Occupational Therapy Examiners, addressed the board to stress that the Board continues to meet its statutory mandate to ensure the public health by licensing and regulating individuals who provide occupational therapy services.
Recommendations by the Committee of Reference
Cochairman Stump moved that the Senate and House Health Committee of Reference recommend the continuation of the Board of Occupational Therapy Examiners for ten years. The motion carried by a voice vote.
Sunrise application of the Arizona Alliance of Non-Physician Surgical Assistants
Presentation by Arizona Alliance of Non-Physician Surgical Assistants
Eugene Smith, Arizona Alliance of Non-Physician Surgical Assistants, addressed the committee to explain that the application now requires licensure rather than certification, which is voluntary.
Senator Leff explained that non-physician surgical assistants are currently in limbo because, although they work in the operating room under a surgeon, they do not have a separate license. She stated they were not getting paid because insurance companies did not recognize their service as they recognize a surgical nurse or a physician’s assistant. Hence, she stated, this profession must be licensed by the state. Further, she said, the Arizona Medical Board is now saying that these individuals are practicing medicine without a license, which can jeopardize the supervising surgeon’s medical license.
Public Testimony
Susie Cannata, Arizona Alliance of Non-Physician Surgical Assistants, addressed the committee to state that this is an attempt to legitimize what is currently going on.
Rory Hays, Arizona Nurses' Association, stated that she is neutral on this but does have concerns regarding educational training, testing, scope of services, and regulation. She also spoke about grandfathering, which is an important step to be taken, but with assurances regarding testing and educational programs.
Recommendations by the Committee of Reference
Senator Leff moved that the Senate and House Health Committee of Reference recommend the Legislature approve the sunrise application submitted by the Arizona Alliance of Non-Physician Surgical Assistants. The motion carried by a voice vote.
Sunrise application of Radiology Practitioner Assistants
Presentation by Radiology Practitioner Assistants
Scott Leckie, Radiology Practitioner Assistants, explained that while radiology assistants (RAs) and radiology practitioner assistants (RPAs) are very similar entities, there is no legislation that recognizes RPAs, which is a fairly new sub-specialty of radiology. He described RPAs as “physician extenders” who free up radiologists in order to expedite patient care.
Public Testimony
Jane Van Valkenburg, Certification Board for Radiology Practitioner Assistants (CBRPA), addressed the committee to testify in support of the sunrise application for radiology practitioner assistants. She discussed the difference between RAs and RPAs, explaining that RPAs have more in-depth education, allowing them to do more things in the clinical area (Attachment 13). She discussed Radiologic Technologists and stated that Arizona currently has no RAs. She stated that needs differ from locale to locale, and urged that the decision on how to use these people should be left to each hospital’s credentialing agency and the supervising radiologists. She stressed that there is room in the profession for both RPAs and RAs.
Senator Leff asked what the difference is between an RA and an RPA; Dr. Van Valkenburg replied that the scope of practice for the RPA is written in broad language to meet the needs of individual hospitals and radiologists, whereas the scope of practice for the RA is quite narrow with a list of allowed procedures. Senator Leff asked for more clarification; Dr. Van Valkenburg stressed that an RPA can work independently, while the radiologist is not in the room.
Senator Leff asked why the American College of Radiology recommends against the RPA; Dr. Van Valkenburg replied that it was a matter of control, that they do not want the more independent RPAs, while the RAs can be controlled by the scope of practice.
Senator Leff asked what type of training the RPA has that he or she can be working independently of the radiologist; Dr. Van Valkenburg described the training and stated that the radiologist must be comfortable with their skills before allowing any independent work that could include invasive procedures. She went on to explain that RPAs do not do final diagnoses and that they are always supervised.
Senator Leff asked why the medical society and the radiologists do not wish Arizona to license RPAs but they do accept RAs; Dr. Van Valkenburg again replied that it is a matter of control.
Chairman O’Halleran asked why there were no radiologists on the CBRPA Board; Dr. Van Valkenburg replied that that would dominate the Board.
Mary Connell, M.D., representing herself, identified herself as a radiologist and stated the importance of having a partner to the radiologist who extends the physician’s services, and that she is in favor of Arizona licensure of either RAs or RPAs, however they are configured.
Senator Leff asked again about the two categories; Dr. Connell replied that the RPAs have a more rigorous training program and seem to have more experience and that she would evaluate each individual to determine their level of confidence and physician supervision.
Senator Verschoor asked if the RAs and RPAs would work under her license; Dr. Connell replied that they cannot in this state as Arizona only licenses radiologic technicians (RTs).
Chairman O’Halleran asked if Utah recognizes RPAs; Dr. Van Valkenburg replied that they recognize them as an extension of the RT. She further clarified that RT is the entry-level position, which then can lead with additional training into other options within medical imaging.
Christine Lung, American Society of Radiologic Technologists (ASRT), testified against the sunrise application. She stated that a radiologist extender is the registered radiologist’s assistant (RRA) with specific education and training requirements. She stated that there are no RRAs working in Arizona because the state does not recognize them.
Senator Leff asked what adding the RRA brings when there are already RTs; Ms. Lung explained that RRAs have an expanded scope of practice, including invasive procedures with direct supervision of a radiologist, and is supported by the ASRT.
John Gray, Grand Canyon University, stated that he supports this application for RRAs, but not RPAs, as long as other agency models are followed.
Joyce Geyser, Arizona Radiological Society, stated her support of licensure for RAs but not RPAs, citing scope of practice reasons in that RPAs want too much independent activity.
James Abraham, National Society of Radiology Practitioner Assistants, addressed the committee stating that he is an RPA practicing in Montana, he is in favor of this application, and he believes that radiologists should define the scope of practice.
Senator Leff asked which states license RPAs; Mr. Abraham replied that it was his understanding that Montana, Oregon, Wyoming, Illinois, Iowa, Florida, Minnesota, Ohio, Indiana, and West Virginia have such licenses, or will soon. Senator Leff asked about scope of practice; Mr. Abraham replied that each state defines its own.
Heather Owens, Senate Health Analyst, explained that Montana statutes allow the Radiology Board to license RAs, which can also be referred to as RPAs, with one scope of practice allowing for direct supervision.
Aubrey Godwin, Medical Radiologic Technology Board of Examiners (MRTBE), explained that the radiologist must be comfortable with these assistants and that this will affect the level of supervision, regardless of the scope of practice adopted by the state. He stated that his Board supports the formation of these assistants’ groups.
Senator Leff asked Ms. Geyser why she is not in favor of licensing RPAs; Ms. Geyser explained that interpretation and diagnosis should not be in any assistant’s scope of practice.
Discussion
Chairman O’Halleran stated his preference for certifying only the RAs due the scope of practice issue, the radiologists’ group recommendation, the AMA’s concern with the test, and ensuring that interpretation and invasive procedures are done by the radiologists.
Senator Leff stated her agreement with his assessment, but asked if this is for licensure, not voluntary certification. Chairman O’Halleran stated that this is indeed for licensure.
Recommendations by the Committee of Reference
Cochairman Stump moved that the Senate and House Health Committee of Reference recommend that the Legislature amend the statutes of the Medical Radiologic Technology Board of Examiners to allow licensure of Registered Radiology Assistants. The motion carried by a voice vote.
Sunrise application of the Southern Arizona Behavioral Health Coalition
Presentation by Southern Arizona Behavioral Health Coalition
Teresa Rodgers, Behavioral Health Coalition of Southern Arizona, explained that this application was submitted in order to ensure that local practitioners meet standards of practice and are licensed. She explained that behavioral analysts use different methodologies and work with patients with various diagnoses including developmental disabilities and autism. She stated that certification began thirty years ago in Florida in mental institutions and has since developed nationwide.
Dr. Rodgers proposes that licensure go forward as a separate entity using the national standards of the Behavior Analysis Certification Board.
Representative Lopez asked if there is a training program in Arizona; Dr. Rodgers stated that Northern Arizona University has a program with 40 students. Representative Lopez asked if there is a real need for this profession; Dr. Rodgers replied that the profession is growing nationwide but it is currently difficult to find enough certified behavior analysts to meet the demand.
Public Testimony
David Giles, Behavioral Health Coalition of Southern Arizona, supports the application, explaining the importance of treatment plans for cognitively impaired people and the requirement that treatment plans be authorized by licensed practitioners. He stated that this profession is the best to treat children with autism.
Senator Leff asked if people practicing now would no longer be able to practice if the Legislature allows licensure; Mr. Giles replied in the negative, explaining that this would provide a way for families to find a clinician. Representative Bradley stated that licensure will actually expand opportunities.
Holly Baumann, Southwest Autism Research and Resource Center, stated her support for this application, explaining that the current lack of oversight represents a significant healthcare risk for some of Arizona’s most vulnerable citizens.
Discussion
Chairman O’Halleran asked for clarification about the motion; Ms. Owens explained the interaction with other Boards.
Ms. Renaudo explained that for her agency the concern is the small number of behavioral health professionals eligible for licensure, and that it would be impossible to regulate it because it will not be self-funding.
Representative Bradley stated that the number is stagnant because these professionals have no place to go, and that with licensure people will be drawn to Arizona. Senator Leff stated her agreement.
Recommendations by the Committee of Reference
Cochairman Stump moved that the Senate and House Health Committee of Reference approve the sunrise application of the Southern Arizona Behavioral Health Coalition. The motion carried by a voice vote.
Sunrise application of the Arizona Dental Association
Presentation by Arizona Dental Association
John MacDonald, Arizona Dental Association (ADA), addressed the group to explain the sunrise application concerning access to care. He described the history of this issue, including the community needs assessments that have been performed, and the meetings with stakeholders (Attachment 14).
Rick Murray, Arizona Dental Association, stated that this program proposes the creation of a position called the Community Oral Health Representative (COHR), designed to be an extender of the dental office and to serve out in the community under the general supervision of a dentist. The goal is to help bring quality dental care to children and families across Arizona.
Anita Elliott, Arizona Dental Association, explained that the primary
role of a COHR will be as community coordinator who provides education and oral
health promotion and prevention, as well as collecting diagnostic information
which is sent to the dental office prior to being seen by the dentist.
Mr. Murray added that the intent is to hire people from within the community, who may then move into other positions in the dental profession.
Public Testimony
Nicole Laslavic, Arizona State Dental Hygienists' Association, stated
that her organization does not support the position but will not oppose this
sunrise application.
Senator Leff asked for clarification of that position.
Janet Midkiff, Arizona State Dental Hygienists' Association, stated that they support the concept of training community people to be dental health representatives, and that the definition of the COHR does make sense to them. She stated concerns about the education, licensing, or certification of the people who fill the COHR positions. She said that her organization would like to work with the ADA and to be a part of the access to care issue.
Nicole Albo, Arizona Dental Assistants’ Association, stated her support for the COHR program provided that the positions will be filled by certified dental assistants with additional training components. She stated that she has been working with the ADA to develop a curriculum for expanded COHR training.
Representative Murphy asked if the committee could approve the concept but not specify the details, letting the Legislative process do that. Mr. Murray stated that the supervision issue is the biggest concern.
Alisa Feugate, Arizona Dental Hygienists' Association, stated that she
supports the concept of the COHR but is neutral on the application at this time
due to concerns about supervision and scope of practice.
Recommendations by the Committee of Reference
Cochairman Stump moved that the Senate and House Health Committee of Reference recommend that the Legislature amend the statutes of the Arizona Board of Dental Examiners to create a new certified professional, the Community Oral Health Representative, to coordinate community-based oral health promotion and provide specified dental care under the general supervision of a licensed dentist. The motion carried by a voice vote.
Without objection, the meeting adjourned at 4:15 p.m.
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Jane Dooley, Committee Secretary
November 6, 2007
(Original minutes, attachments and audio on file in the Office of the Chief Clerk; video archives available at http://www.azleg.gov/)
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SENATE HEALTH AND HOUSE HEALTH
COMMITTEE OF REFERENCE
2
November 6, 2007
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