ARIZONA STATE SENATE
RESEARCH STAFF
TO: JOINT LEGISLATIVE AUDIT COMMITTEE HEATHER OWENS
Senator Robert Blendu, Chairman LEGISLATIVE RESEARCH ANALYST
HEALTH COMMITTEE
Representative John Nelson, Cochair Telephone. ( 602) 926- 3 171
DATE: December 3,2007
SUBJECT: Sunrise Application of the Radiology Practitioner Assistants
Attached is the final report of the sunrise review of the application submitted by the Radiology
Practitioner Assistants, which was conducted by the Senate Health and House of Representatives Health
Committee of Reference.
This report has been distributed to the following individuals and agencies:
Governor of the State of Arizona
The Honorable Janet Napolitano
President of the Senate
Senator Tim Bee
Senate Members
Senator Tom O'Halleran, Cochairman
Senator Barbara Leff
Senator Paula Aboud
Senator Thayer Verschoor
Senator Amanda Aguirre
Sunrise Applicant
Arizona State Library, Archives & Public Records
Office of the Auditor General
Senate Majority Staff
Senate Research Staff
Senate Minority Staff
Senate Resource Center
Speaker of the House of Representatives
Representative James Weiers
House Members
Representative Bob Stump, Cochairman
Representative Nancy Barto
Representative Rick Murphy
Representative David Bradley
Representative Linda Lopez
House Majority Staff
House Research Staff
House Minority Staff
Chief Clerk
HOIjas
Attachment
Senate Health and House of Representatives Health
Committee of Reference Report
SUNRISE REQUEST OF THE RADIOLOGY PRACTITIONER ASSISTANTS
Background
Pursuant to Arizona Revised Statutes ( A. R. S.) $ 32- 3 104, the Joint Legislative Audit Committee
( JLAC) assigned the sunrise review to the Senate Health and House of Representatives Health
Committee of Reference. Attached is a copy of the application submitted by the Radiology Practitioner
Assistants ( RPAs).
Committee of Reference Sunset Review Procedures
The Committee of Reference held one public meeting on November 6, 2007, to review the
RPAs' sunrise application pursuant to A. R. S. § 32- 3 104 and to hear public testimony.
Committee of Reference Recommendations
The Committee of Reference recommends that the Legislature amend the statutes of the Medical
Radiologic Technology Board of Examiners to allow licensure of Registered Radiology Assistants.
Attachments
1. Staff memo.
2. Sunrise request of the Radiology Practitioner Assistants.
3. Meeting notice.
4. An excerpt of the minutes of the Committee of Reference meeting relating to the sunrise
application.
ARIZONA STATE SENATE
RESEARCH STAFF
TO:
CORRECTED HEATHER OWENS
ASSISTANT ANALYST
HEALTH COMMITTEE
MEMBERS OF THE HOUSE AND SENATE Telephone ( 602) 926- 3 17 I
HEALTH COMMITTEE OF REFERENCE Facslm~ le ( 602) 926- 3833
DATE: October 3 1, 2007
SUBJECT: Sunrise Request of the Radiology Practitioner Assistants and the
Registered Radiology Assistants
The following memo is background information regarding the request for regulation of radiology
practitioner assistants and registered radiology assistants. A public meeting is scheduled for
November 6,2007, to review, discuss and make a final recommendation as to the applicant's request. If
you have any questions or need additional information, please feel free to contact me.
BACKGROUND
Rnrliologic Teclznologists - The Medical Radiologic Technology Board of Examiners ( Board)
currently regulates radiologic technologists ( RT) in Arizona. Statute defines radiologic technology as
the science and art of applying ionizing radiation to human beings for general diagnostic or therapeutic
purposes. The Board issues certificates to persons applying to be RTs who are at least 18 years of age,
who successfully complete a Board- approved course of study and who pass a national exam offered by
the American Registry of Radiologic Technologists ( ARRT). Currently seven community colleges and
other institutes offer RT programs in Arizona. RTs may perform x- rays on any part of the body and
they may perform CAT scans. RTs often specialize in a particular area, including: x- ray radiation,
mammography, magnetic resonance, bone densitometry and radiation therapy for cancer patients.
Radiologists - Radiologists are physicians who earn a four- year doctoral degree to become a
medical doctor ( M. D.) or doctor of osteopathy ( D. O.) and complete a four- year residency in diagnostic
radiology or radiation oncology. Radiologists are certified by the American Board of Radiology or the
American Osteopathic Board of Radiology, to indicate that they have passed a standardized national
examination in radiology. Radiologists are regulated in Arizona by the Arizona Medical Board if the
radiologist is an M. D. or the Arizona Board of Osteopathic Examiners if the radiologist is a D. O.
RPAs and RAs - There are two models of advanced radiography practice - the radiology
practitioner assistant ( RPA) and the radiologist assistant ( RA). RPAs and RAs practice at a more
advanced level of radiology than RTs, but they still work under the supervision of a radiologist. There
is an ongoing debate in the radiology industry about what distinguishes the RPA from the RA scope of
practice and whether they should be considered separate groups. Both groups have their own
certification process; RPAs receive certification through an exam offered by the Certification Board for
Radiology Practitioner Assistants ( CBRPA) and RAs are certified by an exam offered through the
ARRT.
MEMORANDUM
October 3 1, 2007
Page 2
The differences between an RPA and an RA are subtle. According to the CBRPA, the required
education for RPA certification is 92- 100 credit hours while RA certification requires 42- 59 credit
hours. RPAs may also perform more invasive procedures than RAs. RPAs may perform initial
evaluations of film images and procedures, while RAs may make observations only. However,
radiologists always provide the final diagnoses and interpretations.
Three of the major radiology associations - the ARRT, the American Society of Radiologic
Technologists ( ASRT) and the American College of Radiology - have indicated support for the title of
RA as opposed to RPA. In an effort to unify the practice of advanced radiography, the ARRT has
created a special eligibility pathway to allow RPAs to earn the RA credential by taking the ARRT
certification exam by December 3 1, 2007. After that date, candidates for ARRT certification must
directly meet all RA requirements. - Other states vary in regulating radiology professions. According to the ASRT, the following 1 1
states regulate the profession of RAs: Arkansas, Florida, Iowa, Mississippi, Montana, New Mexico,
New York, Oregon, Tennessee, West Virginia and Wyoming. Several of the states that regulate RAs,
such as Montana, Iowa and Illinois, allow a person who has passed the RPA exam offered by the
CBRPA to practice under the RA scope of practice. Many states do not address this type of regulation
and leave it up to the individual facilities. There are currently two RPA educational programs in the
United States and eight RA programs. None of these programs are located in Arizona.
REQUEST FOR REGULATION
Arizona does not formally recognize the RPA or RA position. The applicant is requesting that
the Board grant certification to RPAs and RAs in a manner similar to its current certification of RTs.
The applicant suggests that individuals who are already certified RTs and who have completed an
accredited RPA or RA program be granted an extended certification as an RPA or RA. The applicant
requests that the Board implement a system of registration, renewal and suspension or revocation of the
RPA or RA certificate. The applicant states that regulation is needed in order to enforce existing codes
of ethics for RPAs and RAs.
According to the applicant, there are currently six RPAs and no RAs in the State of Arizona.
The applicant states that there will be little or no cost to the Board to regulate RPAs and RAs because
the Board already has the infrastructure in place to regulate other radiology professions. The applicant
suggests that adding a new type of certificate would involve minimal cost and effort by technical
information specialists to make the changes electronically. The applicant does not stipulate the types of
fees that would apply to RPA and RA certification.
SUNRISE REVIEW
APPLICATION FOR REGULATION
INTRODUCTION: -
This is an application for the regulation of a relatively new sub- specialty in
I- adiology called the Radiology Practitioner Assistant ( RPA) and the
Registered Radiology Assistant ( RRA).
Hoth the RPA and RRA are already I- cgulatcd as Radiology technologists by
thc Mcdjcal Radiology Technologists Board of Education ( MRTBE). The
RPA and RRA ccrtil'ications are an cxtcnsion of thc KT liccnse. Therelorc
this is an application for rcg~ ilationr ather th;~ na n increase in Scope of
PI- acticc, as that would affect all RT's and not all RT's are eligible to operatc
under the b~- oadclS- cope of Practice, just those who havc completed
accrcdi~ edp rograms.
Thc diff'crcnccs betwcen thc 2 entities are very small. The main diflercnccs
arc that the RPA has a broader Scope than thc RRA; to enter t12c RPA
pl- ogl- am you have to havc at least 5 years of cxpcl- icncc as an RT, to cnter
tlic RRA, you only nccd onc ycal- and the RPA classes arc graduate levcl ,
while those of the RRA are under- graduate level. However, up until this last
gracluating class, when you graduated li- om the RRA course you had a
bachelors dcgree as opposed to not I- equiring to have one upon graduation
from the RPA coursc. This has since changed and RPA's now have a
bachelors upon graduation.
Hoth entities are viewcd as " super- techs" and can perlhrm invasivc
PI- occdulrs and fluo~ oscopya mongst other things that arc above and beyond
t he scope ol' an RT.
I . A deji'niliorz ( fltlre prwblenz arzd wlzy mgulutiorz is rzecessary:
Wc ar- e applying l'or the rcgulation, both togcther and scparatcly, of
Radiology Practitioner- Assistants ( RPA) and Rcgistcl- cd Radiology
Assistants ( IIRA) , who arc n~ id- levelp roviders in Radiology.
IS there is no rcgulation, thcn thc possibility exists that an untrained
pcl- son could perform procedures on unsuspecting consumers at the
behest of a Physician.
Rcgulation will help consumers to ascertain if a health care worker who
has performed or is going to perform a procedure on them is deemed
compctent and recognized by the State.
Thc extent of autonomy will be spelled out in the Scope of Practice,
which will deal with what procedures can be performed with which level
of supervision by the Attending of Radiologist.
2. Tlze ejforts rrzade to address the problein irzclude:
Members of both of the RPA and RRA health profession have strict
Codes Of Ethics that they adhere to. At this point there have been no
disputcs bctwccn thesc hcalth professionals and thc consumer in this
State, but rcgulation will provide an mcans of rccourse for the consumer
should a dispute arise.
3. Tlze alterrzatives corzsidered irzclude:
The I- cgulation of business employers, who as Radiologists are already
regulated, rather than the employee practitioners, would be harder to
enact due to the vast numbers of the former compared to the limited
numbers of the latter.
The practitioners are all registered and certilicd by their respective
Socicty.
A liccnsc would only attcst to thc practitioner's aptitudc, which has
alr- cady becn ascertained by Board Certification.
These alternatives would not be adequate to protect the public, as they
ol'lcr no rccourse through applicable law for a consumer to settle a
dispute.
4. Jl'lze berzeji~ to tlze public ifrcgulatiorz is grarzted irzcludes:
The public will be ablc to idcntifjl qualified practitioners and know that
they arc competent and arc hcld accountable by a board con~ posedo f
thci~ p- ccrs, Radiologists and a State agency. This Board will administer
thc system of rcgistl- ation, rcnewal of' regulation, suspension or
revocation oS regulation amongst other duties.
The public will he able to idcntify that the rcgillated professionals are
held accountable Sor rcncwal every 2 years by a mcans of both continuing
education and payment of a kc, thus maintaining their competence.
5. Tlze exterzt to wlziclz regulatiorz nzight Izal- nz tlze public irzcludes:
liegulation will not rcstrict cntry into the hcalth profession through
exccssivc restrictions placed to ensure safe and effective perfol- mance. In
lact it is what is nccdcd to open up thc avcnues of entry into this hcalth
profession. 1 do not think that regulation will harm the public in anyway.
6. The t7zairztetzatzce of standards itzclude:
The most cffcctivc quality assurances arc thc standards set by thc
supervising Radiologist. What we do rcflccts on thcm and if we are poor
at our job then they will ultimately be held responsible also. So, il' wc do
not perform at a high level of compctcncc, thcn wc will not bc working.
What Radiologist wants to open themselves up cvcn lurther to the
possibility of litigation against thcm. Howevcr, thcre arc existing Codes
of Ethics Sol- both professions and standards that were set to achicve the
certification.
There is also a I- ccluil- cmcnto f' 50 CEU's biannually to keep you]-
certification curl- cnt as wcll as both entitics having national Boards that
have to be passed to qualify.
The proposed Icgislation will assure quality by adhering to alrcady sct
Codes of Ethics or adopting one entirely or both in part of the cxisting
Codcs of Ethics. Also rcgulation would ensul- c that thcl- e is a PI- occss ol'
suspension or revocation of State rcgulation or certification.
7. A descr- illtiorz Oftlze group projjosedjor regulatiorz:
Both thc RPA and RRA are mid- lcvcl providers in the field of
Radiology. Wc practice under an cxtcnsion of our Radiology
Technologist license with a supervising Radiologist.
Wc arc rcpr- escntcd in this State by many associations, socicties and
groups including thc Medical Radiology Technologists Board of
Education ( MR'TBE), Amcrjcan Registry of' Radiology ' Technologists
( ARKT), Amcrican Collcgc of Radiology ( ACR), Socicty of
Intcrvcnt ional Radiologists ( SIR), National Socicty of Radiology
Practitioner Assistants ( NSRPA) and thc Ccrtil'ication Board 01'
Radiology Practitioner Assistants ( CBRPA).
At prcscnt thcrc are 6 RPA's in thc State of Az and O IIRA's.
Thc groups do ol'l'cr- a vcry small difkr- encc in thc levels of practice, as
thc Scope of' 131- actice lor the lIPA is a little broader than that of the RJIA.
8. Tlze expected costs of regulatiorz irzclude:
Certification of RPA's and RRA's costs to the public will be minimal.
RPA's and RRA's must first be certified with MRTBE as an RT to be
eligible to practice. All the required services and personnel for certification
are in place at the Arizona Radiation Regulatory Agency ( ARRA).
The MRTBE has the personnel and entire infrastructure to add another type
of certification. The costs that will be generated by creating and having a
new type of certificate printed. Adding the new certificate type to the
existing database would also involve minimal cost and effort by the
technical information specialists to make the changes electronically. No
additional personnel will be required because there are only 6 RPA's and 0
RRA's currently residing in Arizona. Evcn projecting an extremely high
number of RPA's and RRA's applying for certification would have a
minimal impact on the MRTRE which already certifies over 7500
technologists.
The cost to the public will be nil because the MRTBE is supported by fees
paid by certificate holders.
Interim agendas can be obtained via the Internet at http: llwww. azleg. state. az. usllnterimCommittees. asp
ARIZONA STATE SENATE
INTERIM MEETING NOTICE
OPEN TO THE PUBLIC
SENATE HEALTH AND HOUSE HEALTH COMMITTEE OF REFERENCE
Date: Tuesday, November 6,2007
Time: 9: 30 A. M.
Place: SHR I
AGENDA
1. Call to Order
2. Opening Remarks
3. Sunset Review of the Board of Homeopathic Medical Examiners
Presentation by Auditor General
Response by Board of Homeopathic Medical Examiners
Public Testimony
Discussion
Recommendations by the Committee of Reference
4. Sunset Review of the Regulatory Board of Physician Assistants
Presentation by Regulatory Board of Physician Assistants
Public Testimony
Discussion
Recommendations by the Committee of Reference
5. Sunset Review of the Board of Behavioral Health Examiners
Presentation by Board of Behavioral Health Examiners
Public Testimony
Discussion
Recommendations by the Committee of Reference
6. Sunset Review of the Acupuncture Board of Examiners
Presentation by Acupuncture Board of Examiners
Public Testimony
Discussion
Recommendations by the Committee of Reference
7. Sunset Review of the Board of Occupational Therapy Examiners
Presentation by Board of Occupational Therapy Examiners
Public Testimony
Discussion
Recommendations by the Committee of Reference
Page I of 2
8. Sunrise application of the Arizona Alliance of Non- Physician Surgical Assistants
Presentation by Arizona Alliance of Non- Physician Surgical Assistants
Public Testimony
Discussion
Recommendations by the Committee of Reference
9. Sunrise application of the Southern Arizona Behavioral Health Coalition
Presentation by Southern Arizona Behavioral Health Coalition
Public Testimony
Discussion
Recommendations by the Committee of Reference
10. Sunrise application of the Arizona Dental Association
Presentation by Arizona Dental Association
Public Testimony
Discussion
Recommendations by the Committee of Reference
1 1. Sunrise application of Radiology Practitioner Assistants
Presentation by Radiology Practitioner Assistants
Public Testimony
Discussion
Recommendations by the Committee of Reference
12. Adjourn
Members:
Senator Tom O'Halleran, Co- Chair
Senator Paula Aboud
Senator Amanda Aguirre
Senator Barbara Leff
Senator Thayer Verschoor
Representative Bob Stump, Co- Chair
Representative Nancy Barto
Representative David Bradley
Representative Linda Lopez
Representative Rick Murphy
+€ w## 7
1 011 9/ 07
s P
Persons with a disability may request a reasonable accommodation such as a sign language interpreter, by contacting the
Senate Secretary's Office: ( 602) 926- 4231 ( voice). Requests should be made as early as possible to allow time to arrange the accommodation.
ARIZONA STATE LEGISLATURE
Forty- eighth Legislature - First Regular Session
SENATE HEALTH AND HOUSE HEALTH
COMMITTEE OF REFERENCE
Minutes of Interim Meeting
Tuesday, November 6,2007
Senate Nearing Room 1 - 9: 30 a. m.
Chairman O'Halleran called the meeting to ordcr at 9: 32 a. m. and attendance was noted by the
secretary.
Mem bers Y resent
Senator Tom O'Halleran, Co- Chair
Senator Amanda Aguirre
Senator Barbara Leff
Senator Thayer Verschoor
Representative Bob Stump, Co- Chair
Representative Nancy Barto
Representative David Bradley
Representative Linda Lopez
Representative Rick Murphy
Members Absent
Senator Paula Aboud
Speakers Present
Kim Hildebrand, Performance Audit Manager, Office of the Auditor General
Todd Rowe, Board of llomeopathic Medical Examiners
Christine Springer, Board of I- Iomeopathic 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
SENATE IIEAL7' 11 AND IIOUSE 11EALTH
COMMITTEE OF REFERENCE
November 6,2007
Joan Reynolds, Regulatory Board of Physician Assistants
Debra Rinaudo, Board of Behavioral Health Examiners
Stuart Goodman, Board of Behavioral Health Examiners
Bev I- lerinon, 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
Kory Hays, Arizona Nurses' Association
Scott Lecltie, 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 I- Iealth 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 I- Iygienists' Association
Janct Midkiff, Arizona State Dental Hygienists' Association
Nicolc Albo, Arizona Dental Assistants' Association
Alisa Feugate, Arizona Dental Hygienists' Association
OPENING REMARKS
Chairman 07Halleran 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 MEDIC
PKrimes enNtailtdieobnr abnyd A, u~ dietorr Gfenoerdalu / d i Mt a nager, Office of the Auditor General, gave a
ings issued in August, 2007 ( Attachment I). She described the history
/ SENATE HEALTH AND HOUSE HEALTH
COMMITTEE OF REFERENCE
November 6,2007
Recommendations by the Committee of Reference
Cochairman Stump moved that the Senate and House Health
Reference recommend the continuation of the Board of
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 ~ s s i s t a d s
/
E~~ genSem ith. Arizona Alliance of Non- Physician Surgical ~ s s i s t d sa, d dressed the committee
to explain that the application now requires licensure than certification, which is
voluntary.
Senator Leff explained that non- physi ts are currently in limbo because,
although they work in thc operating ro hey do not have a separate license.
She stated they were not getting pai ompanies did not recognize their
service as they recognize a surgical assistant. Hence, she stated, this
profession must bc licensed by the st he Arizona Medical Board is now
saying that these individuals arc pract license, which can jeopardize the
supervising surgeon's medical license.
Public Testimony
Susie Cannata, Arizona Allia f Non- Physician Surgical Assistants, addressed the committee
to state that this is an at itimize what is currently going on.
stated that she is neutral on this but does have concerns
of services, and regulation. She also spoke about
be taken, but with assurances regarding testing and
dations by the Committee of Reference
Senator Leff moved that the Senate and llouse 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 KPAs as
SENATE HEALTH AND HOUSE HEALTH
COMMITTEE OF REFERENCE
11 November 6,2007
" 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 WAS, 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 leR to each hospital's credentialing agency and the supervising radiologists.
She stressed that there is room in the profession for both WAS 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
Valltenburg 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'I- lalleran 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 WAS would work under her license; Dr. Connell
replied that they cannot in this statc as Arizona only licenses radiologic technicians ( RTs).
SENATE HEALTH AND HOUSE HEALTH
COMMITTEE OF REFERENCE
November 6,2007
Chairman 0' 1- Ialleran 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 Technolo~ ists ( ASRT), testified against the
sunrise application. She stated that a radiologist extender is the registered radiologist's assistant
( RRA) with specific education and training requiremcnts. 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 ofa radiologist, and is supported by the ASRT.
John Gray, Grand Canyon University, stated that he supports this application for RRAs, but
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 thal 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 I~ is
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 Iiadiology
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 thc level of
supervision, regardlcss of the scope of practice adopted by the state. He stated that his Board
supports the formation of these assistants7 groups.
Senator Leff asked Ms. Geyser why she is not in favor of licensing RPAs; Ms. Geyser explained
that interpretation and diagnosis should be in any assistant's scope of practice.
Discussion
Chairman O'Halleran stated his preference for certifying only the U s due the scope of practice
issue, the radiologists' group recommendation, the AMA's concern with the test, and ensuring
that interprctation and invasive procedures are done by the radiologists.
Senator Leff stated her agreement with his assessment, but asked if this is for licensure, not
SENATE I- IEALTH AND HOUSE HEALTH
COMMITTEE OF WFERENCE
13 November 6,2007
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 AI'PLICATION OF THE SOUTHERN ARIZONA BEHAVIORAL HEAL
COALITION
TPerreessean tRatoidon~ ebrys B, S cohuatvhieorrnal AHreiazlotnh aC Boaelhiativoino roaf l Health Coalition / this application
was submitted in order to ensure that local and are
licensed. She explained that behavioral
patients with various diagnoses including
certification began thirty years ago in
nationwide.
Dr. Rodgers proposes that licensure go forward entity using the national standards
of the Behavior Analysis Certification Board.
Representative Lopez asked if program in Arizona; Dr. Rodgers stated that
Northern Arizona University 40 students. Representative 1, opez asked if
there is a real need for this replied that the profession is growing
nationwide but it is currently certified behavior analysts to meet the
demand.
Public Testimony
David Giles. Behavioral Aealth Coalition of Southern Arizona, supports the application,
e of treatment plans for cognitively impaired people and the
plans be authorized by licensed practitioners. He stated that this
t children with autism.
practicing now would no longer be able to practice if the Legislature
replied in the negative, explaining that this would provide a way for
Representative Bradley stated that licensure will actually expand
Baumann. Southwest Autism Research and Resource Center, stated her support for this
ation, explaining that the current lack of oversight represents a significant healthcare risk
for some of Arizona's most vulnerable citizens.
SENATE HEALTH AND HOUSE HEALTH
COMMITTEE OF REFERENCE
November 6,2007
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 objeclion, the meeting adjourned at 4: 15 p. m.
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. azleri.. gov/)
SENATE HEALTH AND HOUSE HEALTH
COMMITTEE OF REFERENCE
November 6,2007
Arizona State Agency Publications
