March 01, 2018

Scope of Practice Bills Raise Safety Concerns

Proposed legislation in several states would extend the right to order, perform, supervise, and in some instances interpret radiographic examinations to non-physician health care professionals. The following eight examples from six states illustrate the threat such legislation may pose to patient safety and the clinical effectiveness of diagnostic imaging.

The American College of Radiology stresses of the importance of working with stakeholders to assure that such legislative proposals are carefully considered for their potential to adversely affect patient care. Examples of bills related to scope of practice include:

New York AB 4716
The bill specifies that “a licensed physician assistant may engage in the use of fluoroscopy for guidance of diagnostic and therapeutic procedures, provided that the physician assistant has successfully completed an educational program consisting of at least 40 hours of didactic and 40 hours of clinical training with successful completion of a competency exam, as approved by the department.”

North Carolina HB 88 and SB 73
The act seeks to modify the state’s Nursing Practice Act by allowing certified nurse midwives, certified registered nurse anesthetists and clinical nurse specialists to order, perform, supervise and interpret diagnostic studies.

Rhode Island SB 2407
The legislation expanded the scope of practices for physical therapists to include ordering diagnostic imaging studies, provided the exams are performed and interpreted by other licensed health care professionals.

Ohio HB 131
As filed, the bill seeks to modify the definition of "physical therapy" to include “ordering tests, including diagnostic imaging and studies, that are performed and interpreted by other licensed health care professionals.” The substitute version of the bill authorizes only the ordering of standard radiographs (X-ray/plain film X-rays) and requires the radiographs to be interpreted by a board-certified radiologist.

Vermont HB 345
The bill expands the scope of practice for advanced-practice registered nurses in nursing homes would allow them to serve as their patients’ primary care provider of record and perform acts of medical diagnosis, including ordering and interpreting diagnostic tests and procedures.

Utah SB 229
The bill modifies existing statute to allow chiropractors to order diagnostic evaluations, laboratory tests, imaging studies and functional evaluation procedures.

Utah HB 382
The bill modifies the state’s supervision and ordering statute to allow physical therapists to order radiologic imaging if the physical therapist designates a radiology practitioner to receive the results of the radiologic imaging.