Over five years ago, I said 'enough' to bureaucrats in Sacramento. To stand up to them alone seemed like a David and Goliath moment.
So I reached out to ACVP for help. I have never been alone since then. Working as an individual, you can accomplish a lot, but working as a group, like ACVP, you can accomplish whatever you set your sights on.
I am proud to say, we are almost finished with regulations that will protect the future of cardiovascular professionals. Together, we are helping to protect and shape the future of cardiac care.
- ACVP Member, Ed Pezanoski, RCIS
LATEST UPDATE:
CALIFORNIA REGULATIONS TO RELAX ON FLUOROSCOPY
May 5, 2016
OLDER UPDATES
A Step Forward for CVTs in California
ADVOCACY UPDATE FEB. 9, 2016
In October, 2015, the Radiologic Technology Certification Committee in California unanimously passed a motion allowing an individual under the direct and immediate supervision of the S&O to use an assistant in the real time movement of the patient under fluoroscopy, provided that:
- a CRT is present in the room and is managing the radiation exposure and x-ray equipment,
- and that the assistant has the documented radiation safety training required to be established by the facility.
Since our advocacy efforts detailed below, this is a step in the right direction for team-based care in California.
"Prior interpretation had taken away the privilege for physicians and hospitals to choose proper staffing and did not allow for the Cardiovascular Technologist (CVT) to work within their recognized Scope of Practice," summarized Ed Pezanoski, RCIS.
This motion provides the avenue for the Radiologic Health Branch in Calfornia to issue a statement and remove the unnecessary restrictions placed on the S&O and Cardiovascular Technologist with regards to fluoroscopy procedures.
It further allows for the proper interpretation and implementation of the Title 22, Section 70435 regulation which states a CVT shall assist during the performance of all procedures in the cardiac catheterization lab.
The Radiologic Health Branch has committed to evaluate the committee's motion against their laws and regulations and will report back to the RTCC at the next meeting scheduled for April 13, 2016.
If this issue affects you or you wish to support CVTs in California, contact the Calfornia Radiologic Health Branch mentioning your support of the RTCC's motion.
If you have any further information regarding the issue to share, please contact: kurt@cardioce.org. For more background on the issue, continue reading below.
FROM CV DIRECTIONS VOL. 2 NO. 2
The Alliance of Cardiovascular Professionals has been advocating on behalf of Cardiovascular Technicians with the RCIS credential in California.
Title 17 of the California Code of Regulations governing the positioning of patients and equipment during all fluoroscopy procedures requires that these tasks be performed by a professional with a California fluoroscopy permit. Permits are issued after demonstrating adequate knowledge of the procedure via an exam.
The issue at hand is not whether or not RCIS professionals should have to receive a fluoroscopy permit, but rather whether or not they should be allowed to demonstrate their knowledge by sitting for the exam.
As it stands, Radiologic Technologists credentialed by ARRT are the only professionals in California allowed to sit for the exam, and thusly the only professionals allowed to assist during procedures involving fluoroscopy.
Indeed, RTs are an important member of the Cath Lab team, as they bring a deep knowledge base of radiation safety and procedures that is particularly important at a time when it has become clear that radiation is a serious safety issue for Cath Lab professionals. ACVP hopes that RTs working in Cath Labs will lead the charge on changing radiation culture to improve the health and safety of all cardiovascular professionals.
But there are unintended consequences resulting from this legislation. Because it is illegal for them to assist during crucial Cath Lab procedures, CV Techs are being pushed out of Cath Labs in California, and these labs are losing equally valuable members of their teams.
The fact is, this regulation was created at a time when fluoroscopy was not being used in the Cath Lab, and it does not take into account Cath Lab-specific issues that affect the health and safety of patients. It also does not take into account the opinions of the attending physician cardiologists who have argued that RCIS-credentialed employees are qualified to assist during fluoroscopy.
A group of Radiologic Technologists in California has worked against providing an exemption to RCIS-credentialed professionals, arguing that (1) RCIS education in radiology is substandard, (2) that allowing RCIS personnel to assist fluoroscopy is a “de-regulation” of a dangerous procedure, and (3) that this allowance poses a threat to the RT’s scope of practice.
(1) Specific does not mean substandard. While RCIS-credentialed professionals are not educated in the radiography of bones, they are educated and trained in fluoroscopy and radiation safety as it related to the Cath Lab.
(2) While it is illegal for RCIS credentialed professionals to assist during procedures involving fluoroscopy, for which they have been specifically educated and trained, it is not illegal for Radiologic technologists to assist in similarly complex and dangerous cardiac procedures, for which they received no formal education. The fact is, not allowing RCIS professionals to work in the Cath Lab is equally if not more harmful to the health and safety of patients.
(3) The Cardiovascular technician brings a very specific and different set of competencies to the Cath Lab than the RT does. Allowing RCIS-credentialed professionals in the Cath Lab does not affect the RTs scope of practice. Not allowing them in the Cath Lab eliminates the entire scope of practice of the RCIS.
The Alliance of Cardiovascular Professionals firmly believes in a team-based approach to health care, which promotes best practices and quality care. Territorial and political arguments such as these are hurting Californians.
The Alliance of Cardiovascular Professionals recently discovered a more recent regulation in the California Code of Regulations, Title 22, specifically governing the Catheterization Laboratory. This regulation, Title 22, Division 5, section 70435 (a)(3) specifically requires an RCIS-credentialed to be employed in the Cath Lab, specifically recognizing that radiologic procedures are conducted during procedures.
The Executive Director of ACVP, Peggy McElgunn, Esq. recently sent a letter to the Chief of the Department of Public Health, Radiologic Health Branch in California, Mr. Gonzalo Perez arguing that since this regulation incorporates this recognition, it is apparent that Title 17 has been misinterpreted by the Radiologic Technology Certification Committee.
ACVP asks its members, especially those working or who have worked in California, to act now to promote these beneficial changes for which the Alliance is advocating.
The Alliance of Cardiovascular Professionals is always prepared to act in the best interest of quality health care and its members.
Please learn the correct terminology when referring to a medical field that you obviously know nothing about. I am a Registered Radiological Technologist. I am not a technician. If you want to be taken seriously learn about the profession you are attempting to discredit.
Hi Steve,
Thank you for your comment.
1. I wanted to apologize for the typographical error on that page you pointed out. I can assure you that this typo was isolated – we always refer to Registered Radiologic Technologists elsewhere on the site. I also hope you understand that this was simply a mix-up, not an attempt to discredit Radiologic Technologists by referring to them as technicians.
2. I also have to apologize for the tone of the article if you thought it was our intention to discredit Radiologic Technologists. Radiologic Technologists are an important part of our membership, an integral part of the inter-professional cardiac education the Alliance of Cardiovascular Professionals provides, and of course an essential member of the cath lab team. Our stance is in favor of team-based care, and we believe RNs, RTs and CVTs all bring important skills and knowledge bases to the cardiac care team.
This particular issue was also clearly a compromise supporting team-based care. The issue was taken up directly with the Radiologic Technology Certification Committee, so Radiologic Technologists always had direct representation and input in the decisions being made. The recommendation resulting from the RTCC clearly stipulated that they would allow an assistant under direct supervision of the S&O only if a certified Radiologic Technologist is in the room.
This issue only ever affected the scope of practice of the RCIS, not the RT, so our materials may have seemed to credit the RCIS over the RT. This was not our intention, rather, just the reality of the issue at hand.
Of course, I’d love to hear more of your opinion. Again, we represent all cardiovascular professionals – RNs, RTs, and CVTs/RCISs – and we strive to represent and promote the point-of-view of all these groups.
Best,
Kurt Jensen
Communications Director
Alliance of Cardiovascular Professionals
Any developments? Can RCIS either perform the duties they do all over the country while in California or can we sit for the fluro exam?
I am just now learning of this particular issue involving members of our Cath Lab in Washington State. We do not have the fluoroscopy license requirement that exists in California, but many of the ARRT ceritfied techs have expressed concern over the States law that allows RCIS Techs to use ionizing radiation to patients. While I understand fully the points referenced in the above article I must express that very little seems to be known about the actual radiation safety training covered in RCIS curriculum. I am hoping that through this correspondence you might be able to help me and my members uncover specifically what training RCIS tech get. I believe that your goals would be well served to ensure that radiation safety training remains a significant aspect of RCIS training and that these details are made known to Cath Lab teams and managers. I thank you in advance for any assistance that you may be able to provide.
Only 51 registered RT’s in CA? Wow ? sounds like a real shortage. Not check your facts and numbers before you sensationalize and exaggerate the true picture.
I worked with a Grossmont CVT graduate whom had the X-Ray Tube against the patient and the II/FD as far away as possible. I quietly asked him prior to shooting the cross table lateral to move the table (patient) as far away from the tube as possible, and for the II/FD to be as close to the patient as possible. After the case. I asked him where he learned that. He said that was safe practice as far as Grossmont College, CVT School was concerned. I just finished my CEU course on Radiation Protection to maintain my CRT Fluoro License and showed him the picture in the book and the corresponding paragraph. I asked him if the instructor was an RT, he relayed that the instructor was an RCIS.
With that said, I’d have to say that I question the validity of the claim that RCIS’s or CVT’s are competent in their foundations of radiation protection. Do they take classes in Radiation Production, Radiation Biology, Biological Effects of Radiation, Radiation Protection, is their initial reaction to collimate, and use soft filters, and minimize the amount of secondary and scatter radiation that adversely affect the patient, Medical Staff, RN’s and Technical Staff in the room? I’ve never seen a CVT do any. Not saying that none of them do, just never seen it.
So I’ve worked in other states as well as CA and have given drugs, sedation, started IV’s, first line ACLS drugs and shocked patients in life threatening rhythms. Now the CA state law has changed so that only RN’s can do the stated above. Why don’t the CVT’s and RCIS’s fight to be able to do that as well?
Because RN’s have the schooling and competency. If CVT’s and RCIS’s can pass the CA Fluoro test let them try. Keep in mind that you have to attend a semester at a Community College or University on Fundamentals of Fluoroscopy prior to sitting for the CA Fluoro Test. So it’s not like you can study the study guide and pass the exam.
It boils down to this, see what the requirements are to be able to gain employment in the field you want to start your career, obtain that level of education.
So this argument that CVT school is good enough to pass the Fluoro test especially because there are only 51 Registered RT’s in the State of CA, is erroneous in more ways than one.
Nice way to paint a picture to compel your readers to advocate on your behalf. Where I’m from that would be lying. But in the political arena that is a tactic to plant the seed as truth, then let the opposing side present and see if the voters educate themselves enough to consider the other side.
Great article!!!!
Let’s see if you change your stats to show how many RT’s actually have their CA Fluoro License. My bet, you won’t because your not necessarily interested in the truth nor do you have an understanding of what RT’s go through in their schooling to become and RT in CA.
BTW CVT’s and RCIS’s can participate all day long in labs that the MD’s pan. So why don’t the CVT’s and RCIS’s have the support from the MD’s to gain employment? All they have to do is pan and let the CVT’s and RCIS’s inject.
I have taken my ARRT, CRT, CA Fluoro and my CV-CardioVascular Interventional Technologist (through the ARRT) to show that I’m qualified to work in my profession. Keep in mind that the ARRT is governed by the American College of Radiology. Why not approach the ARRT to meet their standards to do a joint venture nationally? Wow there is a concept!!!! Unification to have safe and successful outcomes nationally, not just in CA!!!!!
I have heard in some states they only have RN’s in their CCL’s with no RT’s, CVT’s or RCIS’s. Why are they not banging on those doors? Because that is is in Mississippi and Arkansas and you don’t make as much money as you would in CA.
So my question is, is this about wanting to make CA money or parent care? Just asking.
Hi Rob,
We do not make any money from advocating on behalf of our members and quality patient care. We do not make any money from RCIS education or the RCIS credential. We do not control the RCIS curriculum or the credentialing assessment, which is administered by Cardiovascular Credentialing International (CCI). Here is that information, by the way: http://www.cci-online.org/docs/CCI_RCIS_Exam_Overview_122018.pdf
We DO advocate on behalf of our members, a large group of which were being prevented from working in the cath lab – AT ALL – due to a widespread misinterpretation of existing regulations. A big part of what we argued was that RCIS professionals were simply not allowed to sit for the fluoroscopy exam. We agree with you – “let them try!” MDs do, in fact, support RCIS professionals – another crucial part of this issue was that MDs were being prevented from choosing the makeup of their own teams, even though their license is the only one that matters, in terms of liability, in the cath lab.
We maintain that RNs, RTs and RCIS professionals all bring unique knowledge to the cath lab which improves patient safety and the quality of care. We also hear, anecdotally, an equal number of stories about experienced RCIS professionals being required to train RT or RN professionals with no cath lab experience in issues crucial to patient safety in the cath lab. I personally think a lot of these anecdotal issues come, simply, from inexperience in the environment. Does four years of med school fully prepare doctors for their work? I’d imagine you might have to explain a few things about the cath lab to someone fresh out of med school!
I also want to remind you that the scope of practice of Radiologic Technologists was never threatened or in question. We advocated exclusively through the RTCC in California which was controlled by vast majority by RT professionals! This was simply a compromise to ensure that a misinterpretation was not preventing a wide swath of professionals qualified to work in the cath lab from working – again, AT ALL – in the cath lab.
We also represent members who are RTs – if a misinterpretation of a law (Title 22, for example) were to prevent you from working in the cath lab for which you’ve been educated and trained, we would be there to support you. Please let us know if anything arises threatening your ability to work!
With regards to the 51 RTs statement, I agree it was misleading, and I removed it. I believe it was only 51 RTs educated and credentialed through ARRT to work specifically in the cath lab via the RT(CV) credential. That should have been made more clear, originally. But those numbers have also changed since 2015 when this was written.
Best,
Kurt Jensen
Communications Director
Alliance of Cardiovascular Professionals
There has consistently been only ONE credential that has sought to limit/eliminate other credentials from the cath lab. I’m not going to say which one because we all know the answer. That should be enough to give everyone some insight into what’s really going on here.