TEXAS BOARD OF LICENSURE FOR PROFESSIONAL MEDICAL PHYSICISTS SEPTEMBER 20, 2000 AUSTIN, TEXAS The following board members were present: Paul H. Murphy, Ph.D., Chair Ralph Blumhardt, M.D. Philip Bourland, Ph.D. Kumar Krishen, Ph.D. Adrian D. LeBlanc, Ph.D. Louis B. Levy, Ph.D. Isabel C. Menendez, M.D. Rebecca C. Middleton, Ph.D. The following board members were absent: Shannon D. Cox, M.D. The following Texas Department of Health (TDH) staff members were present: Jeanette Hilsabeck Sallie Howard David Richards Debbie Peterson Jim Zukowski, Ph.D. Cathy Fontaine Ruth McBurney The meeting was called to order at 10:00 a.m. and quorum was ascertained. The guest and board members introduced themselves. Ms. Hilsabeck read changes made to the draft minutes from the September 10, 1999, minutes. Doctor Levy moved to approve the minutes with the changes. Doctor Krishen seconded. The motion carried. The next agenda item was the Chair's Report. Doctor Murphy welcomed Doctors Middleton and Bourland to the board. The governor appointed them on August 9, 2000. He remarked that for the first time in the board's history that there was a full board with no expired terms. He also noted that there were three positions (two medical physicists and one physician) with terms that expire February 1, 2001. Letters have been mailed requesting nominations for the positions. The nominations need to be sent to the governor's appointment secretary. He signed certificates of appreciation for Doctors Bushong and Deiterman who served on the Board for many years and in fact a couple of years past their terms. Unfortunately neither one could be here this morning but we will send their framed certificates to them. Most of the time since the last meeting has been spent working on the rule revisions. The next agenda item was the Executive Secretary's Report. Doctor Zukowski updated the Board on the activities of the department. He noted that during the last legislative session the health department came under Sunset Review. He handed out a draft of the Texas Department of Health Regulatory Review. The Medical Physicists portion of the review begins on page 79. He asked board members to review the report and submit comments to Ms. Hilsabeck. He also distributed the division's web page "hit" list. Ms. Peterson gave an update on the financial status of the Board. For fiscal year 1999 total program costs were $41,000 and $67,786 was collected. Fiscal year 2000 predictions were approximately the same for total program costs and revenue collected. However, the total program costs will be an estimated $55,000. The extra expenses included $7,500 for the state examination contracts, travel for rules committee meetings, and additional attorney and staff time for rule revisions. Dr. Krishen asked, "Does the Board have input in increasing the appropriations or at least inflation?" Ms. Peterson explained that bringing in more revenue doesn't mean we get it. It goes to the General Revenue fund. Excess revenue from the Board goes into general revenue and is not carried over. We cover the cost of programs with the money we are given. There is a Texas Department of Health legislative initiative includes an exceptional item asking for the additional revenue collected be given back to the programs to enhance regulatory efforts and fund additional staff. The Medical Physicists program is included in the initiative. Ms. Hilsabeck reported that information concerning the November 13 and April 23 state examinations had been sent to all temporary licensees. The state medical physicist examination application is also available on the web page. Ms. Hilsabeck attended three rules committee meetings. She also made four presentations to medical radiologic technologists. Currently there are 56 temporary and 326 permanent licensed medical physicists. The next two agenda items (number 7 and 8) were taken out of order to allow longer discussion on the proposed rules revisions. From the Credentials Committee meeting on February 25, 2000, the committee recommended ratification of license approval from a temporary to an annual license for Bing Fang (MNP), annual license approval for Dianne Cody (DRP) and for Miurine Tajiran an annual license (TRP) and temporary license (DRP). Doctor LeBlanc moved for the recommendation of the credentials committee. the motion was seconded. The motion carried. The Executive Secretary recommended ratification of annual license approval for John Bayouth (TRP), Klaus Buzzi (DRP, TRP, MNP), Billy Edge (TRP), Timothy Gao (TRP), Yunxiang Huang (TRP), Steven Kirsner (TRP), John Lowe (MHP), Adrian Markus (TRP), Patton McGinley (TRP), Ira Miller (DRP, MNP), Edward Mok (TRP), Luis Rivera (TRP), Debbie Rothley (TRP), Mohammad Salehpour (TRP), Shared Saraf (TRP). Doctor Blumhardt moved for approval and Doctor Levy seconded the motion. The motion carried. The Executive Secretary recommended ratification of upgrade license approval from a temporary to an annual license for Jon Anderson (MNP), Kyle Antes (TRP), Peter Balter (TRP), Jerome Gonzales (TRP), Suveena Guglani (TRP), Mustapha Hatab (DRP), Stephen Holcomb (TRP), Kang Huang (DRP), Donna Moxley (DRP), Yuenian Zhang (TRP), Xiaohong Joe Zhou (TRP), Marius Alecu (TRP) and Podimannil Philip (DRP). Doctor Levy moved for approval and Doctor Bourland seconded the motion. The motion carried. The Executive Secretary recommended ratification of license approval for Timothy Pethel for an annual license (TRP) and temporary license (DRP). Dr. Menendez moved for approval and Doctor Bourland seconded the motion. The motion carried. Returning to agenda item number 6 discussion and possible action on proposed rules revisions. Related to the proposed rule change of deleting the temporary medical physicist license Ruth McBurney from the Bureau of Radiation Control noted that in certain instances the bureau would look for the signature of the medical physicist especially where mammography, diagnostic, CT, therapy and fluro are involved. Reports by a temporary or unlicensed medical physicist would not be accepted unless it had a supervising medical physicist signature. This led to a lengthy discussion concerning the unlicensed medical physicist. Mr. Richards remarked that the rule review or revision is due to legislative mandate. Every four years you will have to review the rules. The revision is done primarily as a clean up. The legislature did the same thing with the codification of the Act into the Texas Occupations Code from Vernon's Texas Civil Statutes, Article 4512n. Now we are doing the clean up of the rules. Temporary licensure is a hot issue that can be discussed. The Board can decide not to carry this forward as a proposed rules and deal with it at a subsequent meeting. Doctor Murphy noted two proposals: 1) a legislative mandate to clean up the rules and submit proposed rules for publication in the Texas Register and 2) leave the temporary license issue for a later date. Doctor Levy reported that the rules committee had three meetings. The rules were reviewed line by line adding changes mandated by law. The committee also reviewed the temporary license issue and is recommending that it be deleted. Doctor Levy's stand is to grant a license to any medical physicist who is certified by an approved certification board regardless of experience. The concept for eliminating the temporary license, first the person is not fully qualified to practice medical physics independently, they lack experience and are not eligible for board examination. Secondly, an individual whether they have a temporary license or not requires direct supervision. Currently a temporary license can be issued up to four years. There is no incentive for the person to become board certified. By eliminating the requirement for a temporary license, licenses would only be issued to persons eligible for a full license based on board certification. The person who is not certified could still work under someone's supervision. The supervisor would be responsible for them. The supervisor would maintain a list of those being supervised and submit to the licensing board at the time of application for an examination. It would apply to a person who is eligible for a license and wants to work in the state It is against the law to practice medical physics without a license. Ms. McBurney noted that a person in mammography could work under supervision but a licensed medical physicist who also meets the additional MQSA requirements would have to sign the reports. Doctor Bourland remarked that if we take away the temporary license and call them unlicensed and they have currently been under supervision doing mammography, it looks like we would be taking their job away. Doctor Murphy recommended reviewing the proposed changes to the rules but save the temporary license issue until the end. The proposed changes were reviewed section by section. Comments received on the draft proposal were reviewed and were considered during the review. Doctor Levy moved to adopt the concept of the proposed rules as they are written but use the term license eligible medical physicist in lieu of unlicensed medical physicist. Doctor LeBlanc seconded the motion. Discussion followed. Doctor Krishen thought there were two issues. One the question of unlicensed, temporary licensed or license eligible person working with a licensed medical physicist. The second issue is that there are rules that set out the qualifications for the person who has a temporary medical physicist license but there are no guidelines for the licensed medical physicists to follow if there are to be unlicensed physicist practicing under the supervision of a licensed medical physicist If we relegate this responsibility to the licensed medical physicist I feel uncomfortable without giving guidance as to the minimum qualifications of the person they choose as a co-worker. Doctor Blumhardt disagreed. The medical physicist is ultimately going to be responsible and we have to trust his/her ethics. Doctor Levy noted that the motion addresses persons who are board eligible in lieu of issuing a temporary license. Doctor Middleton indicated that the license or board eligible person has the same qualification as one who has a temporary license now. The temporary license would just be eliminated. Doctor Bourland wanted to know what happens to the persons who hold temporary licenses if the temporary license is eliminated. A temporary licensed person is not fully qualified the practice medical physics independently they lack experience, a board examination and require supervision or he would be fully licensed. Objective is that only licensed medical physicist practice medical physics. Doctor Levy wanted to know if the statue authorized the issuance of a temporary license. Temporary license is addressed in the statue. The statue indicates that the board may issue a temporary license to an applicant who has satisfied the educational requirements for a license but who has not yet completed the experience and examination requirements. Doctor Levy called for action on the motion. The motion is to accept the draft proposal, eliminate the temporary license and change the term unlicensed medical physicist to board eligible medical physicists and to adopt these proposed rules with the changes. Doctor Levy voted for; Doctors LeBlanc, Krishen, Middleton, Bourland and Murphy voted against. Doctors Menendez and Blumhardt abstained. Doctor Krishen made a motion to accept all language being proposed and that temporary license be kept intact as it is currently. Doctor Middleton seconded the motion. Doctor Blumhardt noted that the motion was redundant. Accepting all corrections made obviously includes all words concerning the temporary license. Mr. Richards provided clarification on the motion that everything that was impacted by proposed changes to temporary license would go back to the way it is currently. The motion to accept the proposed wording and eliminate all changed made to the section on temporary license. Doctors Blumhardt, LeBlanc, Middleton, Menendez, Bourland, Krishen, and Murphy voted for the motion with Doctor Levy in opposition. The proposal will be sent to the Board of Health for approval to publish in the Texas Register for a 30-day comment period. The next agenda item was public comment. There was no action on this item. The next agenda item was setting the next meeting date. The next meeting was tentatively scheduled for January 24. There being no further business the meeting was adjourned at 2:35 p.m. Presiding Officer Date Executive Secretary Date This was signed by the Presiding Officer Dr. Levy and by the Executive Secretary Jeanette Hilsabeck on March 28, 2001.