Letter to the Editor

The HSRT has actively opposed the CARE Bill over the last 4 years (a timeline and other information is posted at www.hsrt.org). The HSRT Board was neutral during the HSRT membership vote. The HSRT Board decided to allow its membership to vote on whether to support the CARE Bill. The HSRT is the only affiliate society that has allowed its membership to vote on this issue. We feel strongly that the vote of our membership is binding. On July 4, 2006, the HSRT membership voted against the CARE bill by 89% against and 11% for the CARE Bill. We feel the CARE Bill is not good for the profession because it endorses mediocrity at best! It appears to the HSRT that few technologists have taken the time to read, understand and discuss the many ramifications of these bills. The HSRT has taken an active role in informing their membership about the CARE Bill. The HSRT agreed with the ASRT to have an informational session on the CARE Bill for its membership. On September 19, 2004 the ASRT sent 4 representatives to Hawaii to discuss the CARE Bill. The purpose of this meeting was to have an open discussion of the pros and cons of the CARE Bill. 1. Hawaii has one of the best, if not the best, licensing laws in the United States of America. If the CARE Bill passes, our professional standards are reduced by law nationwide. Federal laws always supercede state laws. It will become impossible, over time, to defend Hawaii's higher standards when most, if not all states, will have much lower standards. 2. There are no defined standards in the CARE Bill, unlike PL 97-35 Consumer-Patient Radiation Health & Safety Act of 1981. The federal government will define the standards. The largest, most powerful organizations, such as the American Hospital Association, American Medical Association, American Association for Respiratory Care, American Nurses Association, etc. will make the rules. Instead of the CARE Bill, HSRT supports requiring the mandatory enforcement of PL97-35 after making necessary editorial updates. 3. The bills in the present form endorse less than fully certified or state licensed technologists performing radiological procedures and examinations. 4. The American College of Radiologists (ACR) does not appear to support the CARE Bill. Indeed a public policy statement of James Borgstede, MD, Chair, Board of Chancellors, American College of Radiology Testimony before the Subcommittee on Health of the House Committee on Ways and Means on March 17, 2005 seems to indicate the opposite: The ACR defines a Qualified Radiologic Technologists as ... performs such studies in a facility and possesses unrestricted State licensure and/or certification. The ACR statement includes the radiographer. The ACR is attempting to improve the quality of all radiological procedures in line with the Mammography Quality Standards Act of 1992. This law allows only fully certified radiographers to perform mammograms. The HSRT supports the ACR Principles of Proposed Legislation that states that a fully certified technologist performs examinations for all medical imaging. We are proud of the Hawaii licensure law and the protection it provides to the patients. The quality of patient care we and our colleagues provide is also a source of pride and satisfaction. However, the American Society of Radiologic Technologists (ASRT) Board of Directors have placed sanctions on the HSRT for not supporting the CARE Bill. These sanctions include, but are not limited to, the following: Prohibition of the use of ASRT tax-exempt designation. Denial of free review by ASRT of affiliate-sponsored CE activities. Denial of request for financial assistance. The problem with the passage of the CARE Bill, can be summed up in a statement from the Cath Lab Digest interview by Christine Lung, ASRT Director of Government Relations: It's pretty much anyone's game. Since the standards are set so low in the CARE Bill, it is very possible that they will go even lower when powerful non-members of the Alliance step into the legislative process. Limited x-ray machine operators (LXMO) will get 2 to 8 weeks of training or several courses. Cory Ishihara (Past President HSRT) went to college for two years to obtain his A.S. in Radiologic Technology. Is this really equal to 2 to 8 weeks of training or several courses? One does not have to be a registered radiographer to be an MRI technologist or sonographer, so it seems radiology has given up on those areas. The CARE Bill is a continuation of the great giveaway of our profession. Patient care and radiation safety will suffer due to the lack of education required. The CARE Bill will make all of that legal by federal law! In the current CARE Bill S 2322 there are no less than 6 different vague standards. These standards are as follows: urban or rural, shortage areas or non-shortage areas, experienced or non-experienced. This could possibly result in 36 different combinations of licensed individuals if the current version of the Senate bill passes. It is interesting to note that there are three different states in which the entire state is classified as rural. For example, the entire state of New Jersey is classified as rural for Medicare purposes. Also, two types of institutions could exist within a few miles of one another: one classified as rural and the other as urban. The rural institution could employ limited permit individuals, with fewer qualifications at less pay, while the urban one could not. The experience portion of the Senate bill is another problem. It will endorse anyone who has any experience to obtain a license. How is anyone going to tell what experience is acceptable? There will also be challenges to state laws by outside organizations (i.e., unions, nursing organizations, medical assistants, nurse practitioners, etc.). Are limited permittees, resulting in a fractionated work force with different values of what and how we practice radiologic technology, really what we want? There are quite a few organizations that could influence the passage of the CARE Bill and/or the standards that would be developed by the federal government. Some of these organizations are as follows: the American Hospital Association (AHA), American Academy of Physician Assistants (AAPA), Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), Physician Assistant Education Association (PAEA), American College of Cardiology (ACC), American Association for Respiratory Care (AARC), American Registry For Diagnostic Medical Sonography (ARDMS), Society of Diagnostic Medical Sonography (SDMS), American Society for Clinical Pathology (ASCP), ASCP Board of Registry and any of the nursing groups, since none are members of the Alliance. Many of the groups who are not in the Alliance include physicians and others who can or may perform radiologic procedures and/or interpretations of images. They will become interested groups and will influence the development of the standards if the CARE Bill passes. The setting of standards will become quite a battle between all of these special interest groups. Ultimately, the CARE Bill is very worrisome. It is difficult to think that family and/or friends could be under the care of a limited license person. Will future patients receive the same care that we render to patients now? Ke'aka'okalani Garay, RT(R) President Hawaii Society of Radiologic Technologists Cory Ishihara, A.S., RT(R)(CV)(CIT) Past President, Hawaii Society of Radiologic Technologists Jason Mashino, A.S., RT(R) Past President, Hawaii Society of Radiologic Technologists Clayton Takara, A.S., RT(R)(CV) Past President, Hawaii Society of Radiologic Technologists Visit HSRT's website at www.hsrt.org

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