Medical Imaging and Radiation Therapy Professionals Act and Regulations

1. Medical Imaging and Radiation Therapy Professionals Act and Regulations A presentation to the NSAMRT and NSSDMS Marjorie Hickey,QC marjorie.hickey@mcinnescooper.com June 24, 2010

2. Purpose of Today’s Meeting • Purpose is to approve in principle the Medical Imaging and Radiation Therapy Professionals Act and Regulations, and to authorize the Act and Regulations to be forwarded to external stakeholders for comment and to Government for introduction in the Fall sitting of the Legislature

3. Topics to be Covered • Structure of Act, Regulations and ByLaws • The Purpose of the College and Composition of Board • Framework that incorporates : • Medical Imaging Technology and Radiation Therapy • Five Disciplines (MR Tech: Nuclear Medicine; Rad Tech; Diagnostic Ultrasound and Radiation Therapy) • Scopes of Practice for 5 disciplines • Protection of Titles • Protection of Practice (including grandparenting provisions and exemptions) • Registration and Licensing • Complaints and Discipline • Professional Corporations • Where do we go from here? • Questions?

4. Proposed Structure for Governance • The Act • Creates “College” and provides that the Board is the governing entity • Sets out objects of College • Sets out principal activities of regulatory body • Regulations • Provides details of registration and complaints processes • Bylaws • Largely deal with internal operational matters such as nomination of members of the Board, holding of annual meetings, etc. • Policies • Provides guidelines to various individuals and committees exercising functions under the Act and Regulations

5. New Names • Nova Scotia Association of Medical Radiation Technologists changes to... • The Nova Scotia College of Medical Imaging and Radiation Therapy Professionals • Assets/liabilities of NSAMRT roll into new College • NSSDMS remains a separate Society, with the regulatory function for sonographers taken on by new College • Council changes to… • Board • Radiation Therapy Technologist changes to… • Radiation Therapist

6. New Names cont’d • Radiographic Technologist changes to… • Radiological Technologist • Magnetic Resonance Technologist • A new discipline • Registered Ultrasound Professional • Someone who engages in the practice of diagnostic ultrasound technology (other titles relating to ultrasound are protected)

7. Purpose or Objects of New College • Current purpose of NSAMRT: Section 6 • Increase the knowledge, ability and competence of its members; • Improve the standards of the practice of medical radiation technology so as to ensure that the public at all times receives the services of proficient and competent medical radiation technologists of high ethical standards; • Do such lawful things as are incidental to or conducive to the attainment of such objects.

8. Proposed New Objects • The proposed new objects are as follows: Section 4 – In order to • serve and protect the public interest in the practice of the profession; • preserve the integrity of the profession; and • maintain public confidence in the ability of the profession to regulate itself, the College shall …

9. Proposed New Objects cont’d … the College shall d) regulate the practice of medical imaging technology and radiation therapy; • govern its members in accordance with this Act and the Regulations; • establish, develop and promote standards of practice among its members; • establish, develop and promote a Code of Ethics for its members; • subject to Clauses (a) to (g), and in the public interest, advance and promote the practice of the profession; and • do such other lawful acts and things as are incidental to the attainment of the purposes and objects set out in this section.

10. Composition of the Board • Proposed composition:  a) such number of members as set out in the by-laws;  b) no fewer than 33 1/3 % of public representatives appointed by the Board who: • are not members of the College, and • have shown an interest in serving on the Board. • Criteria for election or appointment of members shall be prescribed in the by-laws (not yet determined)

11. Two Key Umbrella Terms • Medical Imaging Technology • Radiation Therapy

12. Five Distinct Disciplines • Diagnostic Ultrasound Technology • Magnetic Resonance Technology • Nuclear Medicine Technology • Radiation Therapy • Radiological Technology

13. Scope of Practice • Scope of practice defines the parameters of the profession or discipline as a whole • Proposed scope sets out specific illustrations for each discipline and then provides general “catch all” to relate to the practices and procedures taught in applicable education programs.

14. Scope of Practice, cont'd • "practice of medical imaging technology" means: the application of professional medical imaging technology knowledge, skills and judgment in the use of ionizing and non-ionizing radiation, magnetic fields, high frequency sound waves and other energy forms, in the provision of diagnostic and therapeutic modalities, in collaboration with other health care professionals, to achieve optimal health, wellness and functional performance, and includes the practice of: (i) diagnostic ultrasound technology, (ii) magnetic resonance technology, (iii) nuclear medicine technology, (iv) radiological technology, and (v) the practice of any other medical imaging technology discipline set out in the regulations. and includes research, education, consultation, management, administration, information technology, regulation, policy or system development relevant to the foregoing.

15. Scope of Practice, cont'd • “diagnostic ultrasound technology" means those aspects of the practice of medical imaging technology that include: (i) the application of high frequency sound waves to perform procedures and produce high quality diagnostic images; (ii) the education, advocacy and application of ultrasound field safety and the protection of patients, health care professionals and the public; (iii) the assessment of patients before, during and after the application of ultrasound; (iv) the use of pharmaceuticals in the performance of diagnostic interventions to enhance images; (v) the application of knowledge, skills and judgment in the evaluation and interpretation of diagnostic images distinguishing artifact from pathological process and communication of results to the reporting physician; and (vi) such other practices and procedures within the scope of practice of diagnostic ultrasound technology as taught in an approved education program.

16. Scope of Practice, cont'd • "magnetic resonance technology" means those aspects of the practice of medical imaging technology that include:  (i) the use of magnetic fields to obtain pulse sequence data sets and produce high quality diagnostic images; (ii) the education, advocacy and application of magnetic field safety and the protection of patients, health care professionals and the public; (iii) the assessment of patients before, during and after the application of magnetic resonance imaging; (iv) the use of pharmaceuticals in the performance of diagnostic interventions to enhance magnetic resonance images; (v) the application of knowledge, skills and judgment in the evaluation and interpretation of diagnostic images; and (vi) such other practices and procedures within the scope of practice of magnetic resonance technology as taught in an approved education program.

17. Scope of Practice, cont'd • "nuclear medicine technology" means those aspects of the practice of medical imaging technology that include: (i) the use of radiopharmaceuticals to produce high quality images for diagnosis and the treatment of disease; (ii) the education, advocacy and application of radiation safety in the protection of patients, healthcare professionals and the public; (iii) the assessment of patients before, during and after the application of nuclear medicine imaging and therapy; (iv) the use of pharmaceuticals in the performance of diagnostic interventions to enhance images; (v) the application of knowledge, skills and judgment in the evaluation and interpretation of diagnostic images; and (vi) such other practices and procedures within the scope of practice of nuclear medicine technology as taught in an approved education program;

18. Scope of Practice, cont'd • "radiation therapy" means the application of professional radiation therapy knowledge, skills and judgment in the use of ionizing radiation and other energy forms in the provision of therapy, in collaboration with healthcare professionals to achieve optimal health, wellness and functional performance, and includes: (i) the planning for and application of ionizing radiation to patients in accordance with a prescription and instructions from a radiation oncologist; (ii) the education, advocacy and application of radiation safety in the protection of patients, healthcare professionals and the public; (iii) the assessment of patients before, during and after the application of radiation therapy treatments; (iv) the use of pharmaceuticals in the performance of therapy interventions to enhance treatment; (v) the application of knowledge, skills and judgment in the evaluation and interpretation of treatment; and (vi) such other practices and procedures within the scope of practice of radiation therapy as taught in an approved education program;

19. Scope of Practice, cont'd • "radiological technology" means those aspects of the practice of medical imaging technology that include: (i) the application of ionizing radiation to perform procedures and produce high quality diagnostic images; (ii) the education, advocacy and application of radiation safety in the protection of patients, healthcare professionals and the public; (iii) the assessment of patients before, during and after the application of radiological technology; (iv) the use of pharmaceuticals in the performance of diagnostic interventions to enhance images; (v) the application of knowledge, skills and judgment in the evaluation and interpretation of diagnostic images; and (vi) such other practices and procedures within the scope of practice of radiological technology as taught in an approved education program;

20. Protection of Titles • Current title protection: • None • Proposed title protection for the following: • “Registered Medical Imaging Technologist” or “Medical Imaging Technologist” • “Registered Medical Radiation Technologist” or “Medical Radiation Technologist” • “Diagnostic Ultrasound Technologist” • “Registered Ultrasound Professional” • “Registered Diagnostic Ultrasound Professional” • “Registered Ultrasound Technologist” • “Registered Sonographer” • “Sonographer” • “Registered Technologist, Magnetic Resonance” or “Magnetic Resonance Technologist” • “Registered Technologist, Nuclear Medicine” or “Nuclear Medicine Technologist” • “Registered Technologist, Therapy” or “Radiation Therapist” • “Registered Technologist, Radiological Technology” • “Radiological Technologist” • “X-ray Technologist” • Or any derivations or abbreviations thereof.

21. Protection of Practice • No person shall engage in the practice of a discipline unless such person: • holds a license endorsing the person as eligible to practice in that discipline; • is a student in an approved education program in that discipline, and is engaging in training authorized by that program; or • is otherwise authorized to engage in the practice of that discipline as set out in this Act or the Regulations.

22. Protection of Practice, cont’d • Section 21(2) “Notwithstanding any provisions of this Act or the Regulations, the Board may set out in the by-laws a process to authorize members licensed in one discipline to engage in the practice of designated aspects of another discipline”

23. Protection of Practice, cont’d • Exemptions • See Section 67 • Allows for exemptions from Act for various individuals including: • the carrying out of specific tasks constituting part of the practice of medical imaging technology or radiation therapy by persons authorized under Section 21(2) of the Act; • the conducting of ultrasounds of the eye by persons acting under the direction of a medical practitioner; • the measuring of follicles and endometrial thickness as part of assisted reproduction therapy under the direction of a medical practitioner; and • The continued practice of radiological technology by those persons authorized at the coming into force of the Act to engage in practice under Section 10(2) of the former Act, or as otherwise required by law.

24. Protection of Practice, cont’d • Grandparenting provisions • A member of the NSAMRT at the time of coming into force of the Act • A person certified to practice diagnostic ultrasound technology by ARDMS, and who has engaged in the practice of diagnostic ultrasound technology in the Province during the twelve month period prior to Act coming in force. • Every person who, at time of coming into force of Act, has engaged in the practice of diagnostic ultrasound technology in the Province for a period of time during each of the past five consecutive years.

25. Registration and Licensing • Requirements under the Fair Registration Practices Act • Distinction between registration and licensing • Categories of licences: • Practicing Licence, endorsed in a particular discipline • A practicing licence with conditions or restrictions, endorsed in a particular discipline • Temporary licence, with or without conditions or restrictions, endorsed in a particular discipline • Temporary licence (graduate), endorsed in a particular discipline

26. Registration and Licensing, cont’d • Licences endorsed in a particular discipline where member meets the following criteria: • completed an approved education program in relevant discipline; • completed the registration examination in relevant discipline; • Member otherwise meets all criteria for the issuing of a practising licence.

27. Credentials Committee • Credentials Committee reviews applications for registration and licence and determines whether applicant meets criteria • Criteria spelled out in detail in Regulations

28. Registration Appeals • Where registration or a particular licence has been denied, or where terms or conditions have been imposed, an applicant has a right of appeal • Appeal will consist of fresh review of entire matter, with new decision to be rendered by independent body, Registration Appeal Committee

29. Complaints • Complaints may relate to potential: • Professional misconduct • Conduct unbecoming the profession • Incompetence • Incapacity

30. Complaints and Discipline Process • Separation of complaints/investigative process from discipline/hearing process • Introduction of alternate dispute resolution methods to avoid necessity of matter proceeding to a hearing • Requirement for disclosure and fair processes • Requirement for open hearing if matter is referred to full hearing

31. The Investigation of Complaints • Broad authority given to investigator • Following investigation, matter referred to Investigative Committee and various options available to dispose on nondisciplinary basis • If matters reach the Investigative Committee, various options are available to dispose on non-disciplinary basis • Counsel • Caution • Informal resolution • Mediation

32. Settlement Proposals • When a matter is referred to a hearing, either party can approach the other regarding a settlement • Settlement requires admission of certain facts; admission of disciplinary matters; and agreed upon disposition • Both Investigative Committee and Professional Conduct Committee must review and approve content of settlement

33. Hearing Process • Professional Conduct Committee includes public representatives • Full disclosure by either party to the other • Open hearing process • Ability to impose publication bans • Publication of decisions • Right of appeal • Reinstatement applications

34. Professional Incorporation • Act allows for members to practice under the structure of a professional corporation • At present, no Regulations proposed to set out requirement for majority ownership by technologists or therapists • This can be adapted over time with additional changes to the Regulations

35. What Happens from Here? • June 24, 2010 Members vote on Act and Regulations • Obtain approval to proceed • Approved Act and Regulations to be circulated to Government and to external stakeholders for feedback • Consultation with 3 political parties between August and October 2010 • Changes made based on government feedback • If government agrees, Act introduced in fall sitting of Legislature 2010

36. What happens from here?(cont’d) • Act introduced for First and Second Reading, then public Law Amendments process • Can be a very political process- may need to lobby support • Third Reading • If Act passes in fall sitting of Legislature 2010, Regulations are then forwarded to Registry of Regulations • Anticipated proclamation date - early to mid 2011 ???

37. Questions? ?????

38. Motion • Be it resolved that at a duly called Special Meeting of the members of the NSAMRT held on June 24, 2010, the proposed June 10 version of the Medical Imaging and Radiation Therapy Professionals Act and accompanying Regulations are approved, subject to necessary housekeeping amendments, for forwarding to government and external stakeholders, with the objective of introduction in the fall sitting of the Legislature

39. Motion • Be it resolved that at a duly called Special Meeting of the members of the NSSDMS held on June 24, 2010, the proposed June 10 version of the Medical Imaging and Radiation Therapy Professionals Act and accompanying Regulations are approved, subject to necessary housekeeping amendments, for forwarding to government and external stakeholders, with the objective of introduction in the fall sitting of the Legislature