PAs performing fluoroscopy

[kittryn]

I am in MA and our practice uses fluoroscopy. as a PA, and within this practice, I have been taught how to use the fluoroscopy machine to perform (and interpret) UGIs for our patients but...(big but)...we have had no FORMAL training/ceritification, and although we wear shields (body/neck), we have not been given badges to measure exposure. I might perform 3-5 fluoros/day. same with the NP who also sees pts with me (don't know NP requirements for procedures regarding ionizing radiation).

 

I work in a private practice and have questioned them about our need for badges, which they promise they will provide (they have until next week, then I start asking again).

 

my question is a few-fold:

 

1) fluoroscopy performed by PAs in MA is only in legislation -- it is not passed yet.

 

2) am I covered in doing this under "scope of practice"?

 

3) are private practices subject to oversight by OSHA, ARRT, JACHO, or some other organization in regards to occupational safety, esp with regard to procedures involving ionizing radiation?

 

4) we (midlevels) have not received specific training in fluoro -- and I believe such training is the law. don't know if laws are federal or state-determined.

 

I am not seeing much updating in the state-specific forum -- so does anyone know if I should stop performing fluoro (it is very key to many of our pt evaluations)? I don't want to give up my pay, but wonder if I have grounds for paid leave until they get this clarified. I think they could get shut down if they are violating state and/or fed laws, but I don't if they are violating the law or not. I can't find much of anything online with regards to oversight of private practices performing fluoro, and which agencies should be involved.

 

I began performing fluoros with this practice under the assumption that my "scope of practice" guidelines would cover me, but I am starting to smell a rat in that 1) we do not wear exposure badges and 2) there is no formal training 3) there is no agency oversight and 4) THEY DON'T BILL FOR THE FLUORO -- would this indicate they are performing procedures using ionizing radiation without proper oversight? why would a practice not bill for such a lucrative (and bill-able) procedure?

 

jesus, I am getting such an eye-opener with what a private practice might try to get away with...it is very discouraging as I am a trusting person who cares only about pt care, and only seem to get wise to sh*tty practices as I spend time with individual providers.

 

any (EXPERIENCED) input would be appreciated (please no random speculation if you do not know what the deal is here, thanks).

 

kittryn

[ToppDog]

This does sound fishy to me. If you haven't been trained, are they even having you keep track of the levels of radiation & the amount of time the pt is being exposed in seconds etc. ??? If not I think I would run, not walk, away from there & look for work elsewhere. Overexposing patients is a hot issue right now with the recent screw up with CT's in the news, & who knows if someone would decide to make an example out of this practice or not, & you wouldn't want to be mixed up with that if they do. I know nothing of the laws in MA, but it doesn't sound good to me at all. Hopefully someone with better info will chime in soon.

[kittryn]

thank you for your input. there's a lot of weird sh*t there, actually, and I think I need to talk to a lawyer. I don't really want to pay the price of leaving (ie, no income); my idea would be more like paid leave until we get things sorted out. or they can lay me off so I can collect UE while I look.

[DizzyJ]

I was working in veterinary medicine the last time I was dealing with radiation, but we still had to follow OSHA laws. They required our private, veterinary, practice to provide each individual with a radiation badge (if that person was over 18 and was going to have exposure) to track exposure. We turned these in quarterly to a private company that submitted a report back about our radiation exposure. There is no way you can do this with a log book on your own. Sorry...i can only speculate that OSHA would also apply to your private practice as well. :)

[scut-monkey]

OSHA definately applies to private practice, and if the state regs don't currently include ionizing radiation, then you are not practicing within the regs. I'd contact your state society and see if they can give you clarification regarding the regs.

[rcdavis]

Kit,

 

You have, or are about to, kicked a hornet's nest.

 

First thing :protect your license. I agree 100% with scutmonkey. Call and make an appointment with the state board medical examiners... They will have in house attorneys and expert advise on the central issue... Can you do what you are doing under the MA laws? If so, the other issues such as special certifications required to do it, safety, OSHA,NRC requirements can be addressed and enumerated for you. If not, then you will be advised, perhaps formally to stop.

 

What you do not want is for the board to find out second hand what you are doing if doing so ain't legal... In the least that will end up with a public censure, a letter or reprimand, or at its worse, a suspension of your license.

 

As mentioned above, the board's primary concern is the protection and safety of the MA citizenry in matters medical. Their secondary concern is to help you practice legally.

 

Tell them. Coming forth with the question and your concerns will save your license if that would be an issue. Downside? They will investigate the surgeon's practice. I believe that he has to be registered with the state to use radiation in any( therapeutic or diagnostic) form. And that he has responsibility to protect both patients and staff from the effects of exposures( signed consents if pregnant,etc), and keeping fluro-time logs for everyone.

 

He may have picked up a fluoro-unit on his own, and be using it in an inappropriate manner.

 

In which case the board - under the auspices of patient/civilian safety- will not be happy and may well censure him.

 

Unless he is fully in compliance ( and I suspect that he is not, for the reasons you have surmised) they will investigate his practice thoroughly. And will issue a cease and desist order. And may even require him to retrospectively notify each exposed patient of possible over-exposure. Which would make him legally exposed for whatever length of time child bearing women who were exposure would take until they have clearly exited any possible exposure during an unknown pregnancy, and if they were pregnant, until the kids reach majority. Not a pleasant thought.

 

You primary concern is to salvage you license. So far, you are innocent it seems. But At The Point That you became suspicious of these activities' legalities, you are obligated to investigate and clarify the issue. Go straight to the PA rep or the PA specialist on the board. Bring your facts and get their advise. aSAP.

 

They may tell you that you are okay as far as they are concerned, but that you should take some extra precautions.

 

They. Probably will not say that, though. They may well tell you to stop immediately, and give you suggestions on what you have to do to "get legal".

 

You may lose you job. Better that than your license.

 

The horse has left the barn. Get to the state and see what you can do now to close the barn door.

 

Jesus, good luck.

 

If I can help (research, insight, etc) let me know.

 

davis

[ventana]

RC has great advice but there has been a lot of work already done in this state...... talk to the AAPA state Rep, MAPA (Heather Tafton I think)

 

Don't push the panic button yet - - - lots of work being done in the state with the help of a few people like Heather and some other PA's.

 

 

Talk to the state PA board and ask for the minutes that upport Fluoro as being a task PA's are okay - they even have an opinion from the State Medical board (I think....)

[d2305]

I think that a ugi has 600 x the radiation that a cxr has. The mrem add up.

[kittryn]

RC has great advice but there has been a lot of work already done in this state...... talk to the AAPA state Rep, MAPA (Heather Tafton I think)

 

Don't push the panic button yet - - - lots of work being done in the state with the help of a few people like Heather and some other PA's.

 

 

Talk to the state PA board and ask for the minutes that upport Fluoro as being a task PA's are okay - they even have an opinion from the State Medical board (I think....)

 

thanks so much. I will do this. I have emailed heather but never have heard back. this just spurs me on further. I will try calling her and try to get to the bottom of this.

[kittryn]

Kit,

 

You have, or are about to, kicked a hornet's nest.

 

First thing :protect your license. I agree 100% with scutmonkey. Call and make an appointment with the state board medical examiners... They will have in house attorneys and expert advise on the central issue... Can you do what you are doing under the MA laws? If so, the other issues such as special certifications required to do it, safety, OSHA,NRC requirements can be addressed and enumerated for you. If not, then you will be advised, perhaps formally to stop.

 

What you do not want is for the board to find out second hand what you are doing if doing so ain't legal... In the least that will end up with a public censure, a letter or reprimand, or at its worse, a suspension of your license.

 

As mentioned above, the board's primary concern is the protection and safety of the MA citizenry in matters medical. Their secondary concern is to help you practice legally.

 

Tell them. Coming forth with the question and your concerns will save your license if that would be an issue. Downside? They will investigate the surgeon's practice. I believe that he has to be registered with the state to use radiation in any( therapeutic or diagnostic) form. And that he has responsibility to protect both patients and staff from the effects of exposures( signed consents if pregnant,etc), and keeping fluro-time logs for everyone.

 

He may have picked up a fluoro-unit on his own, and be using it in an inappropriate manner.

 

In which case the board - under the auspices of patient/civilian safety- will not be happy and may well censure him.

 

Unless he is fully in compliance ( and I suspect that he is not, for the reasons you have surmised) they will investigate his practice thoroughly. And will issue a cease and desist order. And may even require him to retrospectively notify each exposed patient of possible over-exposure. Which would make him legally exposed for whatever length of time child bearing women who were exposure would take until they have clearly exited any possible exposure during an unknown pregnancy, and if they were pregnant, until the kids reach majority. Not a pleasant thought.

 

You primary concern is to salvage you license. So far, you are innocent it seems. But At The Point That you became suspicious of these activities' legalities, you are obligated to investigate and clarify the issue. Go straight to the PA rep or the PA specialist on the board. Bring your facts and get their advise. aSAP.

 

They may tell you that you are okay as far as they are concerned, but that you should take some extra precautions.

 

They. Probably will not say that, though. They may well tell you to stop immediately, and give you suggestions on what you have to do to "get legal".

 

You may lose you job. Better that than your license.

 

The horse has left the barn. Get to the state and see what you can do now to close the barn door.

 

Jesus, good luck.

 

If I can help (research, insight, etc) let me know.

 

davis

 

thanks so much, RC, you are awesome. I know how much you help other ppl on this board and I am grateful to have your opinion and offer of help. I have to take this very seriously and get to the bottom of it. I think ventana is on track with his suggestions, and I will make some calls tomorrow. it is really scary -- esp in terms of pt exposure, my exposure, this stupid yahoo doc...they bought the fluoro used, and it is maintained by a company, but I don't think there is any OSHA oversight from what I can tell. I reviewed my scope of practice and it says NO FLUORO, so I guess I better not perform any until I get this clarified.