Chapter 1: How Standards Are Created

State Legislative Process

How does an idea move through the legislative system and become official? Read a case study that illustrates the process of how laws that govern the profession come to be put into effect.

Case Study

Sue Beam and Sam Ray work as radiologic technologists at a small rural hospital in a state that does not license medical imaging and radiation therapy professionals. Sam and Sue are registered radiologic technologists and provide excellent care to patients who need imaging examinations. Their hospital decides that it needs to offer more diagnostic services and adds on three new “radiology technicians.” Because their state doesn’t require licensing for anyone performing medical imaging or radiation therapy procedures, three people are hired away from a local car dealership to learn how to perform diagnostic imaging examinations and provide quality patient care.

During their break one day, Sam and Sue discuss their situation and say, “There ought to be a law.” Knowing that health care workers who do not meet education and certification standards can compromise diagnostic image quality, the effectiveness of treatment and, ultimately, the safety of the patient, Sam and Sue discuss the issue during a meeting of their state society.

Research and Drafting

Sam and Sue discover through their research that other radiologic technologists in hospitals all around the state are experiencing the same issue, and they agree to spearhead a legislative initiative to ensure that all people in their state who perform medical imaging procedures or administer radiation therapy treatments meet licensure standards and that a program is developed that will give the state authority to determine the qualifications needed to legally practice radiologic technology. After putting together their legislative committee, the state affiliate applies for the ASRT Affiliate Advocacy Program (AAP) and the legislative committee starts researching the laws for radiologic technologist licensure in nearby states. Through the AAP, a survey is sent to all ASRT members in the state asking about registered technologists’ attitudes toward licensure and whether there are other R.T.s willing to help or serve on the legislative committee. After analyzing the situation occurring in their state and what direction the affiliate wants their bill to take, the committee works with ASRT to start drafting a bill to present to the state legislature.

Support and Discussion

While drafting their bill, Sam and Sue realize that it might affect other health care workers. In fact, they don’t realize how many people in a large variety of settings are performing medical imaging examinations. In a few physicians’ offices, nurses are being asked to perform medical imaging, and chiropractors are instructing their assistants to obtain spinal images. After discussing this with the legislative committee and also with the state nursing association and chiropractic association, the affiliate legislative committee determines a limited-scope permit is in order, as long as the person performing the examination meets appropriate educational and competency assessment standards to perform only a specific type of examination on a designated anatomical area. As news of the radiologic technology bill gets out to the medical community, other health care groups start calling. Some groups support the legislative initiative, but some have concerns and suggestions. Sam and Sue know that it is important to secure support for the bill and to discuss and mitigate opposition to their legislative endeavor. Like any type of negotiation process, some requests are reasonable and could be written into the bill, while others raise dissension.

Looking for a Sponsor

After fine-tuning their draft bill and securing the support of some professional groups affected by the legislation, Sam and Sue start looking for sponsors to introduce the bill in the state house of representatives and state senate. After talking to the other members of the state society, they find out that Representative Smith, whose district houses the largest hospital in the state, has a close tie to the radiology community. They also talk to Senator Jones, whose daughter is a radiologic technologist in an orthopedic clinic in another town. Rep. Smith and Sen. Jones are also members of the House and Senate Health Care committees — the first committees that will review the bill after it is introduced.

Introduction

Rep. Smith and Sen. Jones, after a little persuasion from Sam and Sue and some visits and phone calls from radiologic technologists living in their districts, decide to introduce the bill in the House and Senate. The House version of the bill (House Bill 1) is introduced and referred to the House Health Care Committee and to the House Professional Licensure Committee. The Senate version (Senate Bill 2) is referred to the Senate Health Care Committee.

Committee Hearings

The House Health Care Committee decides to take up H.B. 1 quickly and schedules a committee hearing on the bill. Sam and Sue prepare some written comments to submit to the committee and also prepare a short speech telling committee members why H.B. 1 is important for patient care. They also closely scrutinize the bill and prepare answers for any questions the committee members might have. During the hearing, Rep. Smith asks Sue and Sam to express how the education and qualifications of the person performing a diagnostic imaging examination can affect the quality of the medical image produced and how licensure will positively affect health care in the state. Sam and Sue explain who they are, the education and experience they possess and how they contribute to the patient care team. The House Health Care Committee agrees that people performing medical imaging and radiation therapy procedures should be licensed and meet education and competency standards. They vote and report H.B. 1 favorably with no amendments.

Meanwhile, in the Senate, S.B. 2 progresses through the Senate Health Care Committee just as it did in the House. Sen. Jones and Rep. Smith communicate with their colleagues to ensure the bill’s success. Sam and Sue encourage R.T.s to write, call, and visit their state senators and representatives to express support for H.B. 1 and S.B. 2.

H.B. 1 moves to the House Professional Licensure Committee. During that hearing, it is learned that the podiatric community wants podiatry assistants to be able to perform foot and ankle x-ray examinations under the supervision of a podiatrist. Because a provision for this is not included in the original language of the bill, Rep. Foote, a member of the committee, proposes an amendment that is voted on and adopted. H.B. 1 is reported favorably with amendment.

S.B. 2 is placed on the Senate calendar and H.B. 1 is placed on the House calendar for their second reading. The second reading opens the bills up for floor debate. The state's R.T.s meet at a gathering hosted by their affiliate society and go to the state capitol to rally for their bills. There is little debate in the House, except for one representative's attempt to tack another professional licensure bill for fast food workers on to H.B. 1 as an amendment. Her amendment is defeated, and H.B. 1 is placed on the calendar for its third reading.

In the Senate, things are a little more exciting. Debate over S.B. 2 rises from senators whose physician constituents are concerned that they will not be permitted to perform medical imaging examinations themselves because they do not directly meet the specified standards for licensure contained in the bill. Sam and Sue realize that this was an oversight and work with the physicians to develop some exemption language to be amended into the bill. Sen. Jones explains the proposed amendment that will permit licensed physicians to perform and supervise licensed individuals performing medical imaging and sponsors it on the floor. The amendment is adopted, and S.B. 2 is placed on the calendar for its third reading.

Upon the third reading, each bill is voted on and passed by its respective chamber. Now H.B. 1 goes to the Senate and S.B. 2 is heard in the House. In essence, the whole thing starts over again. Each bill makes it through the committee process and the second reading for floor action. Representatives and senators start to realize there are two versions of the bill that vary slightly, and decide to call a conference committee together to come up with a compromise. The conference committee discusses the differences in each bill, combines H.B. 1 and S.B. 2 into an entirely new bill  —H.B. 3 — and issue a conference report. H.B. 3 is placed on the calendar in the House and Senate and is passed by each chamber with unanimous consent. H.B. 3 is enrolled and sent to the governor for signature.

The governor reads the bill and signs it into law with R.T.s from the state looking on. From there it goes into the rule-making and regulatory process, which will be covered in a future chapter.

Communication Is Key

This case study demonstrates how a law gets passed, but there are always two sides to every story. If a bill needs to be defeated, there are many parts of the process that can be affected. Committee hearings and contact with legislators can also be used to voice opposition to legislation and to propose alternatives that might be more agreeable. In the legislative forum, open, constant, direct and honest communication with lawmakers is key.

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