CA - Assembly Bill 407 will cause extreme radiation exposure to Patients in California
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Assembly Bill 407
Why this bill is bad for patient care
Written by: Coalition of concerned Radiologic Technologists in California
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Assembly Bill- 407 (AB -407) will allow unskilled physicians, podiatrists and chiropractors to operate dangerous radiation equipment; this bill is headed through the California State legislature. If approved, this bill could lead to patients receiving excessive and unnecessary radiation doses that could cause them serious over radiation exposure to innocent patients who entrust their doctors with their healthcare. Currently, California is the only state where registered radiographers, and physicians and surgeons need to study, apply and pass for the state fluoroscopy permit. This is due in part to the Radiologic Technologists (RT) Act. This act was created in 1971, to protect the public at large. The act mandates that the person behind the fluoroscopy machine, an equipment that produces ionizing radiation, is certified; but moreover, that the fluoroscopy licensed team has had the necessary education, and training, and they are certified in fluoroscopy. This certification and permit assures patients & staff that during procedures they will receive the lowest dose of radiation possible. Unfortunately, AB-407 is inching its way to become reality, unless patient advocates and concerned citizens inform their representatives that AB 407 is bad for patient care.
The existing mandate has assured countless patients whom undergo routine, elective and emergency surgeries and exams, the confidence that the surgeon and radiographer will do whatever is necessary to minimize radiation dose for the patient. Fluoroscopy is primarily used in hospitals, surgery and pain management centers, joint centers and more! They are being used in many applications. Some include: bone replacement (e.g. hip replacement), cardiac surgery, interventional procedures, stent placements, and many more applications.
AB-407 will EXEMPT physicians, surgeons and chiropractors from taking the California Fluoroscopy Operators and Supervisors permit, thereby providing the convenient option of paying for the permit, without taking the exam. I explained this to my sister by saying; “it is like someone paying for a medical degree without having going through the education to get one.” Going through the process of being certified is a true litmus test of academic integrity and knowledge. An individual who studies, takes and passes & gets certified achieves a higher sense of knowledge thereby increasing outcomes, which in turn improves patient care.
The argument being made by several organizations who supports AB-407, “to obtain a fluoroscopy and radiography permit under current California law, physicians and surgeons, and doctors of podiatric medicine, are required to undergo a laborious and lengthy examination process that can sometimes take months to complete, start to finish.” ( (Glazer, 2019)
Wait a minute??… isn’t obtaining any permit and license laborious? In fact, don’t you want it to be a laborious effort? Nothing comes easy! More importantly, what about patient care? Patients who give their ultimate trust and care to surgeons need to be confident that every step is taken to ensure that the procedure is not only done correctly, but also performed with the least radiation possible. AB 407 does not provide this. Being non-certified is non-qualified.
It is important to note, according to the Radiologic Health Branch of California (RHB), the accrediting arm of radiology for the State of California, indicates that approximately, 8, 800 individuals are certified as Supervisors & Operators (S&O) Fluoroscopy Permit holders. With only an 83% pass-rate, the idea of passing AB 407 seems irresponsible! Surgeons and doctors that need to operate the fluoroscopy equipment must have thorough understanding of topics such as: radiation protection, radiation biology, and radiation physics. This guarantees that a mechanism is in place to ensure that patients who undergo medical procedures will receive the lowest dose of radiation. While a majority of other states do not require certification for fluoroscopy, radiographers have been educated in these important topics. Radiographers serve as radiation safety experts in the surgical suites, and we constantly inform and remind the surgeon about dosage during the case.
Supporters of this proposed legislation indicates that the Joint Commission now requires hospitals and ambulatory care centers “specifically require that hospitals and ambulatory surgical centers must verify and document that individuals who use fluoroscopic equipment participate in ongoing education that includes annual training on radiation dose optimization techniques, and safe procedures for operation of the equipment.” P. 3(Glazer, 2019). While this may have been the case, the Joint Commission has now redacted this information. Hence, supporter’s argument that this is a duplicative process is untrue. They also claim this will streamline the process and “allow physicians to enter practice more quickly.“ Glazer, 2019). To change a legislation that will allow physicians to practice medicine more quickly is not what the RT Act was created for. The RT Act was created to protect the public, and if this legislation passes, the RT act will be compromised.
The California Radiological Society and the California Society of Radiologic Technologists, both who fervently oppose this legislation argues that the existing process works. It requires those who wish to operate the fluoroscopy equipment to study, take and pass the California Fluoroscopy permit.
Physicians need to demonstrate knowledge of radiation safety practices and with the pass rate of 83%, there needs to be more oversight, resources and education, not less. The need for certification for surgeons is not only needed, but the best for patient care. The RT act should not be water down for the sake of a physician wanting to open their practice sooner. What’s next? A legislative bill to allow non-pharmacists the ability to refill your prescriptions? Perhaps a bill that will allow physicians without an oncology background to treat patients with cancer? As outrageous as these two examples above; do you think that AB-407 may also fall in the same category? To allow non-skilled, non-certified individual to operate a machine that produces (potentially) large quantities of ionizing radiation to you or your loved one? Tell your local California representatives that AB 407 does not promote patient care. Remember, non-certified is non-qualified. To find your representatives click here
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