On June 11, 2008, Governor Strickland signed into law Substitute Senate Bill 229 (the “Law”), which will go into effect on September 9, 2008. The Law creates a new, licensed medical position under Ohio law called a Radiation Assistant (“RA”). Individuals performing the tasks of an RA will not have to be licensed as RAs under the Law until June 9, 2009. The Law is intended to license and regulate a group of medical care activities that fall outside the scope of practice of Radiation Therapy Technologists (“Rad Techs”) and other medical technicians, and will appear at Section 4774.01 et seq. of the Ohio Revised Code.
I. Radiation Assistant Scope of Practice
The Law defines an RA as “an individual who assists a radiologist in the care of radiology patients by engaging in any of the [following activities]”: (1) performing fluoroscopic procedures; (2) assessing and evaluating the physiologic and psychological responsiveness of patients undergoing radiologic procedures; (3) evaluating image quality, making initial image observations, and communicating observations to the supervising radiologist; (4) administering contrast media, radio-isotopes, and other drugs prescribed by the supervising radiologist that are directly related to the radiologic procedures being performed; and (5) performing any other radiologic procedures specified by the state medical board in rules. The Law also specifically states that RAs cannot do the following, all of which remain the physician’s responsibility: (1) interpret radiologic images; (2) make diagnoses; (3) prescribe therapies; or (4) administer or participate in the administration of general anesthesia, deep sedation, moderate sedation, or minimal sedation.
II. Supervision Requirements
The Law requires that RAs must be supervised by a either a doctor of medicine or osteopathic medicine who is actively engaged in the practice of radiology. The radiologist must provide on-site supervision (i.e., be physically present in the same location, but not necessarily the same room, as the RA) for all procedures performed by an RA, including those involving a patient under minimal sedation. However, when the patient is under general anesthesia, deep sedation, or moderate sedation the RA must be directly supervised by the radiologist (i.e., the radiologist is physically present in the same room and within direct site of the RA). Subsequent rules regarding the Law may add to the list of procedures for which more than on-site supervision is required.
III. Affect on Radiation Therapy Technologists
It is believed the Law was passed by lawmakers as a reaction to a concern that Rad Techs were performing procedures beyond their scope of practice pursuant to the physician delegation statute (O.R.C. 4731.053(B)). This statute provides that a physician may delegate a task to unlicensed persons provided that the task is not one for which licensure is required, the person is competent to perform the task, and the task is one in which there is a minimal risk of harm to the patient. Concerns had been raised that delegation was occurring as a convenience to the physician for tasks in which competency was not being appropriately established. By creating a licensure requirement for RAs, those acts that come within an RA’s scope of practice may no longer be performed pursuant to the physician delegation statute. Rather, in order to perform any of these acts, the individual must be licensed as an RA. Rad Techs will continue to be able to perform the tasks specifically authorized by statute and regulation, as well as any other tasks that can be appropriately delegated to them. It is unclear at the present time as to what impact this legislation may have regarding scope of practice for registered nurses and whether the regulations will address this issue.
The Ohio Department of Health is responsible both for licensing Rad Techs and for rule-making regarding Rad Tech practice. However, under the Law, RA’s will be licensed by and under the authority of the Ohio State Medical Board. Under the Law, the Ohio State Medical Board must promulgate rules and be prepared to accept and process applications for RA licensure and issue certificates of licensure no later than March 9, 2009.