APRN Supervision of Fluoro and Gonadal Shielding - 01/15/2020

The Oregon Health Authority Radiation Protection Services issued notification that they have officially filed final rules for advanced practice registered nurses (APRN) supervising fluoroscopic operations and to discontinue patient gonadal shielding. Changes in these rules became effective Dec. 13, 2019.

Due to the passage of Senate Bill 128, APRNs who has obtained an Oregon Board of Medical Imaging (OBMI) Limited Fluoroscopy Supervision Permit may provide personal supervision to radiologic technologists who have a permanent or temporary license issued from the OBMI to operate fluoroscopic.

Oregon Administrative Rules (OAR) Division 106 amends OAR 333-106-0015 by repealing section (5) which currently requires the X-ray technique chart to indicate the need for gonadal shielding and OAR 333-106-003 is repealed in order to discontinue the requirement of providing gonad shielding to the patient during diagnostic X-ray procedures. 

OBMI Meeting Notes - 10/19/2019

Find notes from the latest OBMI Board Meeting here

Highlights from the meeting include:

• Licensure fee increase to $168 is still scheduled to take effect July 1, 2020.
  
• Consideration of public comment for rulemaking of SB128. The board will move forward with rulemaking for the APRNs to supervise fluoro. 
  

SB 128 Passed

Senate Bill 128, which would allow Advanced Practice Registered Nurses to supervise licensed radiologic technologists in the performance of fluoroscopy procedures, was passed in both the Senate and the House of Representatives and is headed to Gov. Kate Brown for her signature. A link to the version of the bill as approved by the House on May 9, 2019 is located at this link.

Highlights of the bill:

• APRNs will not be allowed to operate fluoroscopy units, but can only supervise the performance of fluoroscopy by licensed radiologic technologists. There are no provisions in SB 128 that allow APRNs to operate the imaging equipment. This will require radiologic technologists to be diligent and not let APRNs operate fluoroscopy equipment.
• APRNs have to meet fluoroscopy-specific educational and fluoroscopy examination requirements as defined by the Oregon Board of Medical Imaging. 

If you have any questions or are interested in serving on the OSRT legislative committee please email osrtoffice@osrt.org.

SB 128 - Update

(February 21, 2019)

On Monday, February 18, SB 128 was introduced by the Senate Committee on Healthcare for the 2019 legislative session. The OSRT was represented at that hearing and a couple of members testified regarding this matter. Nurses were also present at the hearing and provided their opinions of this bill, which included requesting that they not have to take a competency exam. Details from the hearing, including video and written testimony can be found here. 

At this time OBMI will continue to work on rule making which will follow this proposed bill pretty closely and will ensure the Advanced Practice Registered Nurses will need to meet additional education and clinical requirements in order to supervise fluoroscopy. 

OSRT will continue to stay informed on the progress of this bill and notify our members when new details emerge.

Public hearing set for SB 128

(February 12, 2019)

This bill is scheduled for a public hearing and possible work session by the Senate Committee on Healthcare at the Capitol this coming Monday, February 18th at 1:00pm in HR A. The session is open to the public and you are encouraged to attend. Representatives from OSRT will be present for the hearing and we welcome other technologists who are willing and able to join us.

Senate Bill 128 would allow Advanced Nurse Practitioners to supervise Fluoroscopy

(January 26, 2019)

The OSRT legislative committee was recently notified of proposed Senate Bill 128. Linked here is a draft of the bill for your review. The bill would allow Advanced Nurse Practitioners to supervise fluoroscopy if they've met standards set by OBMI. These standards include an education component, a clinical component and requires them to pass an ARRT exam. This bill would not allow them to operate fluoroscopy, but rather supervise/direct technologists.  

As you aware, this has been an ongoing issue for the past few years and the proposal has certainly come a long way. The original proposal by the Oregon Nurses Association (ONA) requested the ability for Advanced Nurse Practitioners to order, perform and interpret all imaging studies. Through working with the Oregon Board of Medical Imaging and Radiation Protection Services, the newest proposal (SB128)  would ensure that those Advanced Nurse  Practitioners supervising fluoroscopy would have to complete specialized education and prove competency.  

Next Steps: 

The OSRT legislative committee is watching the proposal closely and plans on having a representative attend any meeting where the Senate healthcare committee will be discussing this proposal. It is extremely important to have technologists in the room during these discussions to ensure our voices and concerns are heard.  We will also watch for any amendments to the proposal.  You can continue to check the website for updates.  

Upcoming agenda item at OBMI board meeting regarding APRNs supervising flouroscopy 

(October 15, 2018)

The OSRT legislative committee would like to inform all OSRT members that the Oregon Board of Medical Imaging will be discussing a "Review of legislative draft for APRNs to be authorized to supervise fluoroscopy procedures ."  At this time public comment is not open on the proposal, but OSRT welcomes your opinions on the issue. 

To share your thoughts on the issue, please email osrtoffice@oregonsrt.org

Update on the ONA proposal to allow nurses access to fluoroscopy

(May 2, 2018)

The request from the Oregon Nursing Association to allow Advanced Nurse Practitioners to supervise fluoroscopy was discussed again at the OBMI meeting on 4/20. The board did not want to move forward with allowing the ARPNs the ability to supervise fluoroscopy by changing statutes. They recommended that a representative from the board should meet with the leaders or the Healthcare Committee from the Senate. The board felt it would be important to meet with Senators Greenlick and Monnes-Anderson to explain OBMI's perspective on the issue. A few of the board members mentioned there was never a needs assessment done to confirm there is a true need to have the nurses operate and/or supervise fluoroscopy and it was not a good idea to change statute to accommodate a few requests.

We will continue to keep you posted as this discussion continues. Please check our website frequently or contact our legislative committee to find out how you can be involved.

OBMI Board Meeting Notes - April 22, 2017

New Business:

1. Proposed rule to establish civil penalty schedule for employing an unlicensed person to perform imaging.  

• OBMI is drafting a proposal to fine facilities for employing an unlicensed person.  They voted to accept a proposal which would fine institutions based on the number of individual patients served.  The proposed fee schedule is as follows:
• • $5,000 if service was provided to no more than 50 patients.
  • $10,000 if service is provided to 51-100 individual patients
  • $20,000 if service is provided to 101-150 individual patients
  • $30,000 if service is provided to 151-200 individual patients
  • $50,000 if service is provided to more than 200 individual patients
• There was discussion on this as one of the board members felt like the fines were too harsh especially considering rural organizations, but the board ruled to proceed with the proposal noting the penalties need to be significant enough to detour facilities from using non licensed employees to operate imaging equipment.
  
• I asked if this would apply to current situation of APRN's reportedly using fluoroscopy while performing pain management injections and the reply was yes.
• Next steps:  This will go to public comment.  

2. Five year review of specified administrative rules, in accordance with ORS 183.405.

This was just a procedural item as they must review their administrative rules every 5 years.  No discussion to note.  

3.  Proposed policy for handling public records requests

• Policy on how to request public records including fees to obtain public records was approved.  Currently OBMI will only release the name and address of a licensee.  

4. Planning future election of Board Chair and Vice-Chair.

• This was an informational item from Ed that there will upcoming elections so for those board members who might be interested in serving ad chair or vice chair, they should let Ed know.

Old Business:

1. CT waiver request – follow-up question following the Board’s January action on CT waivers.

• Last meeting there was a request for a CT waiver from a rural hospital which was denied.  A CT tech from this facility has attempted to take her CT registry with ARRT three times and has failed.  ARRT will not allow her to sit for another test, but OBMI could sponsor her to take the ARRT test which would apply to Oregon only.  Meaning if she were to pass the exam administered by OBMI, but written by ARRT she would only be allowed to practice at her specific site and in Oregon.  She would not be able to practice anywhere else and would not be considered ARRT registered.  
• The board had mixed feelings on allowing her to test for a 4th time.
• Currently the facility has 9 CT techs.
• Next steps:   The board requesting the site prove that not having her employed has created a hardship.

2. Board action regarding possible rulemaking regarding supervision of temporary limited permit holders

• The rulemaking is still in process for supervision and the board suggested that the RAC meet again to clean up some of the language on the proposal.  
• Tom King reported an inspection with Pioneer Pacific's LXMO program in Wilsonville and it passed inspection.  He mentioned their organization of student records was lacking and the rooms were very messy which was concerning to him if students were picking up on these habits.  
• They held student interviews which reflected the organization concerns from instructors.  
• There was also much discussion on the extremely low pass rates and Rick Hoylman said these scores were unacceptable and the schools should be held accountable.
• Next steps:  Tom will continue to inspect LXMO schools and the board put in a request to the board's attorney to see if OBMI has the authority to hold the school accountable to their low registry scores. The attorney will investigate whether or not the board can step in and consider issuing sanctions against LXMO who have poor registry pass rates.  

3. APRNs providing verbal instructions during fluoroscopy procedure—update on SB 801.

• SB 801 legislation was pulled.  There has been no contact from ONA on the proposal.  

4.  Update on OBMI’s legislative concepts for the 2017 session in Salem. 

• HB 2267 for Opthalmic Sonography was signed by the Governor.  

5. Update on legislative action on the OBMI budget for the upcoming 2017-19 biennium.

• Informational only.  Nothing noted.  

The June 2016 issue of the Oregon Board of Medical Imaging newsletter is available now on the OBMI website. Articles include: 

• Beginning in 2017, you must have CT credential to perform computed tomography

• Rule proposed to establish a four dollar renewal surcharge to pay for health workforce database
  
• Board sponsors five legislative proposals for the 2017 session in Salem
  

• Volunteer to serve on the board of medical imaging
  

 You can find the newsletter here: http://www.oregon.gov/OBMI/docs/Newsletter-OBMI-June-2016.pdf

OBMI meeting held April 22, 2016

1. A privately owned orthopedic clinic out of Eugene made a request for an exemption to the CT credentialing requirement for R.T.s who operate low-dose CT equipment. Their facility has been researching a low-dose, weight bearing CT scanner for feet and ankles only. Due to the low radiation dose and the limited number of studies they would likely order, at least initially, the physicians in their group wondered if they could allow an RT to do the scanning at that machine in lieu of a credentialed CT technologist.

2. Following a random inspection of limited licensing educational facilities; the question arose if the students in these programs are being appropriately supervised during the clinical portion of their training. It was brought to the attention of the board that a number of years ago the state law was changed to indicate that students of limited licensed programs must apply for and pass the ARRT certification exam and then obtain a temporary permit from the OBMI before being allowed to enter the clinical part if their training. See OR Statue 337-010-0030

3. There was a suggestion during the public comment session to request that OBMI remove the need for applicants to disclose that they have had an arrest. Currently the board requires applicants to disclose arrest, convictions, warrants, etc. The person requesting this change felt that if an applicant wasn’t actually convicted of a charge then they shouldn't have to disclose the related arrest. However, from the board’s perspective applicants are being asked to honestly disclose all the information and as long as the background check lines up with what has been provided there is no further action taken by the board. This is more of an issue about integrity and disclosing the whole truth.