Birth of a Cath Lab Law
- Volume 19 - Issue 9 - September 2011
- Posted on: 9/6/11
- 9 Comments
- 8288 reads
The HB 2430 ran into formal opposition from the Washington Society of Radiological Technologists (WSRT) and its President-Elect, Pamela Lee.
Ms. Lee’s main opposition was based on the amount of radiation safety training the RCIS students received. She testified that radiation burns are on the rise in cardiac cath labs due to the lack of training.
Following her testimony, there were no questions by the committee to Ms. Lee.
On January 28, 2009, HB 2430 passed the vote of the full House of Representatives by a vote of 97-0. It was then sent to the Senate Committee on Health and Long Term Care.
Testimony for HB 2430 was heard by the Senate Committee, and the bill was passed by the full State Senate, in a 45-0 vote.
The nation’s first law recognizing the Cardiovascular Invasive Specialist as a certified profession was signed into law by Governor Chris Gregoire on March 17, 2010.
The Aftermath
For Representative Morrell, the victory stood as one of her biggest accomplishments. The passage of HB 2430 had the rare distinction of passing as a bi-partisan, unanimous victory. “Not all bills come this easy,” she says. “Sometimes they can take up to 10 years to fight their way into law.”
Representative Morrell, a Democrat, was especially thankful to the ACC and was quick to point out that bi-partisan support was also key. “I had (State Representative) Bill Hinkle on the Republican side help me out. He is a paramedic and has dealt with cath labs for years.”
So where do RCISs around the country, facing the same issue, go from here?
House Bill 2430 can have a positive effect across the country in other states. Individual state DOH may recognize the value of the RCIS in cardiac cath labs, but have similar struggles with developing the scope of practice in cath labs. Washington State House Bill 2430 can provide a template for finding ways to solve potential liability issues.
Representative Morrell agrees. “This law can become a template. It happens all the time. For instance, we (Washington State) used the same law passed in Oklahoma to regulate sales of Sudafed. We said ‘Hey, we like that idea. Please send us your legislation.’”
But Ms. Morrell warns that passage of similar legislation in other states may not come as easy as it did in Washington. For such an important field, the RCIS is smaller and less organized nationally than other organizations.
Ms. Morrell suggests that technologists holding the RCIS are going to have to bind together and approach their state representatives in groups. She also suggests RCIS professionals seek out state politicians aware of what goes on in a cath lab and seek the backing of their national organizations.
It is apparent that many things need to come together for legislation like HB 2430 to be passed in other states. This may require coordinated efforts of state hospital associations, DOH in individual states and the power of national organizations such as the Society of Invasive Cardiovascular Professionals (SICP) and the ACC.
RCIS programs should also become involved, since their funding may be at stake. In order to maintain the highest professional standards in America’s cardiac centers, the CCI exam is still the standard for measuring knowledge and competency, and it is these programs that are the pillars of the RCIS.
It is also going to take the knowledge of people who have been there before. “I’d love to help organize this,” said Representative Morrell. No doubt others in the State of Washington feel the same.
In the fall of 2011, the DOH will roll out the announcement as to when the new certification will be required for all Washington State cath lab technologists. As of this writing, Representative Morrell, RN, is no longer in the House of Representatives. She continues her work as a cath lab nurse for Good Samaritan. William Sims, RCIS, MBA, is now the operations manager for the Cardiovascular Procedure Unit at the University of Washington Medical Center. Dr. Fishbein still holds office for the Washington State Chapter of the ACC and is an active practitioner at the University of Washington. Co-authors James McRae, RCIS, and Scott Corson, RCIS, testified at the Senate Hearing.
James McRae can be contacted at I_claudio2000@yahoo.com.
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This has been a problem in other states as well. Why can't the care bill proceed and a license created for the field of Cardiovascular technology? Is this asking too much. The registry doesn't hold much water in several states. The field is more technical than it ever has been. The demands of our profession should be recognized. The responsibilty in some labs has doubled with the mix of hybrid and radiology cases. We need better reprsentation NOW. Lets not just talk about it, lets get it going.
Reply to this comment »I could not agree more. I went through a two year program with CCI accreditation and obtained RCIS credentials, and am able to preform my profession very well. I am very heavily relied upon from the doctors and staff during and post diagnostic and interventional procedures. It's a real shame that only certain professions who are cross trained in the cath lab get respect that ALL people should who do an equal amount of work and share the knowledge we have in the Cath lab. I wonder if our cohorts know how much education we under go to obtain an RCIS credential, and how much we are capable of doing. Perhaps having two more letters behind our name makes us, "More capable" to do our jobs... and that's the sad part. RCIS spend two years learning all cardiac procedures and are ready to hit the ground running after graduation, however if laws do not change we will rely on cross trained people that carry other credentials to carry out the future of the Cath lab. In my lab all we have is RCIS and RN's, and from the doctor's view, they have made it clear they are happy to have already trained professional's ready to preform procedures. Rather then having to cross train others that carry a degree to hit a pedal, but have no idea how to do a simple diagnostic cardiac procedure. May be one day if law changes we can work equally to benefit the patient and gain the much needed respect we deserve as professionals.
Reply to this comment »Your "cohorts" really don't care about your actual training. They know from working with RCIS that we are skilled at our scope of practice. This is ALL about RT's feeling threatened and trying to eliminate us from the cath lab. It's about MONEY. The RT's got scared in the 2000's because cath lab directors were hiring more RCIS than RT's , saving money since RT's weren't needed as often to troubleshoot xray failure or run films. While the RT's could have worked in CT, MRI, ED, and god-forbid, RADIOLOGY (to name a few), they decided to push us RCIS out, basically condemning us to poverty or a forced-change of career. Their lobbyists are using rare xray burns and a few anecdotal horror stories about OJT CVTs who "killed" or injured patients, to scare state legislators into requiring flouro licenses for ALL techs employed in the lab. (Nevermind the fact that we almost NEVER step on the pedal.)
This is a selfish territorial attack on the RCIS profession by RT cowards who pose a MUCH greater risk to patient by injecting air or making an error in the other 90% of the crucial high-tech equipment that WE RCIS ALONE have trained to use, which the RT's use after "OJT" cross-training, while crying about us panning the table at the DOCTOR'S DIRECTION.
Until we stand together and remove these RT's from our cath labs, we risk elimination in EVERY state. It's already nearly impossible to get RCIS work in IL, CA, and many other states.
Reply to this comment »i too an rcis. i read your article and i notice your cathlab only has rcis and rns. we work on a 4 member team. a monitor tech, xray tech, scrub tech that is xray licensed and an rn. they use xray for scrub me the rcis for monitoring and xray to do the power injections and get the catheters balloons and supplies. and the rn to give meds. most the time the xray and rn is just standing there and they dont answer the phone most the time. i do all the monitoring and they wont cross train me to scrub due to the xray contrast. but they do have one girl that they do allow that is only rcis, tech. she is not suppose to be injecting contrast or even doing the femoral injections for clossure device. how do yall do it on a 3 man team. who monitors to pay attention to rhythm and record all documentation on everything and why would they allow and rcis to scrub. this article i read really makes me think the rcis is not worth what i paid. i have been in the cath lab since 1996 and only get to monitor and occasionally circulate for pacemakers. and further more the cost of our education test and license is ridiculous. and the amount of ceus is more than and rn or rt. what is your input on this. i would love to hear back from you. thanks christine at chmills1@sbcglobal.net
Reply to this comment »Please if I may--I have been in the Cath Lab for 23 years. I am ARRT and very proud of it.
I went through 2 gruelling years radiology training and one year speciality in CCL/Specials. If I may say so I have traveled throughout the US in Cath Labs and have been very dissapointed
with what I see RCIS people do with radiation. As a matter of fact I have been horrified with the limited knowledge. Just because you can't see or feel radiation, there seems to be no respect of what it can do. In the hands of "some" RCIS I think is a huge mistake. They do not have enough training and should not be acting as X-ray Techs. We should work together in the CCL, but please know your limitations. Not all RCIS are alike--I understand that as not all RT's are
alike, but more the greatest majority more extensive training needs to be done.
Thank you,
Reply to this comment »c
Like wise rts are not trained in cath lab and as a cvt with an aas in cath lab technology, i too went through grueling years of training specific to the field i work. I think its time arrt get of its high horse and recognize those with formal training. Rts are trained ojt in cath lab its not taught in xray school. We all need to respect eachothers education and stop cutting eachother at the knees.
Reply to this comment »You are very correct in what you say and I do agree with you. I have also been surprised in what other RCIS do with radiation. All cath lab professionals need to know their strengths, weaknesses, and limitations. I was fortunate to go through a two year CCI approved program that did enforce radiation safety, however they could not possibly fit what you learned in two years. The good news is by 2012, CCI will only give RCIS credential for individuals who have gone through an accredited program, which is now enforcing radiation safety much more then in previous years. Where as in past years it was not as difficult to gain an RCIS, which would explain the not so up to par staff.
Reply to this comment »The sad reality, and what I was getting at, is the cath lab has become a turf war at who can work there. It is becoming extremely difficult in certain states to work in a cath lab without ARRT credentials. Many cath lab job openings do not even consider RCIS, rather you must have ARRT (No CVT knowledge is necessary) that can also pose danger to the patient just as RCIS not knowing the ins/outs of Rad safety can. If more people choose to think like the lady or gentleman above, we would be working as a much better team to benefit not only the patients but also our own personal safety. The key is just as you said, not all RCIS are alike, and if co-workers realize that, the one's who are clueless could be let go of and the ones who really know what's going on could gain the respect. I do not think only RCIS should work in the lab, I have always said if RT's and RCIS work together there is so much knowledge at the table that can help patients and staff it's unbelievable. However I know of some RT's who seem to make it a passion to get all RCIS out of the lab, and not even take any educational background into consideraion.
The way most labs operate that I have been in, the MD operates the fluro equipment, and techs (Rather RCIS or RT) really do not use the xray. Knowing this, it is a very sick/nerve racking feeling that my profession could be wiped out if I do not gain further credentials. Suppose I do obtain ARRT, and continue my job, I still won't be using x ray in the lab just like now. I really resent when people assume RCIS is a joke and we just breeze through our program (I know you are not saying that). I personally know people who were cross trained for the cath lab who have no idea about hemodynamics or pathophysiology involved in cardiovascualr procedures, however only work in the lab because they know more about radiation. I have a lot of respect for the RT's who took the time to get educated in CVT and are very capable to do their job. I am NOT judging other professionals who really do great things in the lab and know many things. I am not a fan of the one's who really do not know the ins/out of cardiovascular technology and are only there because the hospital wants only RT's and does not take educational background into play. I agree that not all RCIS/RT's/&RN's are alike, but we all need to have the respect that anyone should have (Assuming we earn that respect). I really think a bridge program would be an excellent idea to have RCIS gain the knowledge needed to operate fluro, just as RTs can bridge to CVT. If we were to bridge over, pass the board and gain a license it would put everyone working in the lab on the same level. I am sure you know just as I do, there can be a lot of hostility among cohorts and that could become a thing of the past. Unfortunately, until legislation changes the fate of my future career in the cath lab is really up in the air.
Before this reply turns into an epic novel, let me just toss a thought out to all the people who do not want RCIS in the lab at all. Suppose the tables were turned, and you were shunned out and told not to return to the lab (after working there for so many years). You know you know the job, but no one wants or even cares to listen to your side. I would really like to see all the staff take the RCIS exam I took and see how they all do. I really think the bickering and turf war needs to stop, and realize that we can all work together and share our knowledge. No one who holds valid credentials and knows their job well should be told you are not need here anymore...
It dismays me to see that turf wars are still alive and well in the invasive cardiology world. All disciplines have expertise and knowledge to share, making everyone around them better able to perform their duties. I am biased in this opinion, for I have always worked with a variety of credentials, including RN, RT, RCIS, EMT, RRT, and surgical technologists.
What I take exception to in this article is this snippet: "Ms. (Pamela) Lee’s main opposition was based on the amount of radiation safety training the RCIS students received. She testified that radiation burns are on the rise in cardiac cath labs due to the lack of training." Ms. Lee's argument would have merit if she were referring to x-ray procedures performed without a physician present. For that, absolutely a certified/licensed RT is necessary. That is not what happens in a cath/EP lab.
Radiation burns are on the rise in the invasive cardiology and EP lab environments because procedures are longer and more complex, leading to increased radiation doses to the patient. It is not due to lack of training. Lab staff are doing these procedures with modern digital x-ray equipment, which emits a comparatively lower dose than in the past. The cardiologists performing these procedures are also trained in radiation safety and operation, and are ultimately responsible for the radiation dose received by the patient.
I wish we could all work together, not against each other. Our patients deserve better.
Janette LaFroscia, RCIS, RCES, RCS
Reply to this comment »EXACTLY.
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