Letter to Governor Hogan regarding Care of cardiovascular patients in Maryland during the Covid-19 epidemic
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The MDACC will engage with lawmakers and regulatory staff to ensure that Marylanders receive the best cardiac care and improve heart health.
Back in the cold month of January, your Maryland ACC was asked by an FACC member and by a hospital in our state to support legislation which would create a licensing process for Registered Cardiovascular Invasive Specialists (RCIS) under The Board of Physicians which would allow RCIS-credentialed personnel to assist cardiologists with cath lab fluoroscopy in addition to providing other technical support. Under current Maryland law, only Radiological Technologists (RT) are allowed to provide such assistance. This request came to us in response to a severe shortage of qualified cath lab technologists with an RT credential to support the increasing number of primary and elective angioplasty programs in the state. This shortage has forced some hospitals to temporarily close some lab rooms and to bear the high costs of hiring temporary staff and requiring increasing overtime of existing staff, which carries additional risk of staff burnout.
After carefully reviewing the issue, MDACC leadership decided to support the initiative. Despite our support as well as the support of nearly every hospital in Maryland, SB1087 / HB1008 did not advance out of committee and were referred to a Board of Physician study committee which is to issue a report in the fall. Dr. Marty Albornoz and I have been participating in meetings of this committee along with a diverse group of stakeholders.
Cardiovascular technologists pursuing an RCIS credential generally study for up to 2 years in a community college setting learning the spectrum of skills required to assist in interventional cardiology and EP procedures, including assistance with fluoroscopy, receiving 30-50 hours of classroom instruction in radiation physics, theory, and safety specific to fluoroscopic equipment. The ACC has recognized the RCIS credential for many years. Maryland’s Howard Community College has an excellent training program which prepares cardiovascular technologists for the RCIS credential. Unfortunately, most graduates of the program have to leave the state to practice in Virginia, the District of Columbia, Pennsylvania, and Delaware – all of which allow RCIS personnel to practice the full scope of their training. In fact, Maryland is one of the only states in the US which does not allow RCIS’s to assist cardiologists with fluoroscopy.
Opponents of the initiative cite concerns about safety, but can point to no data which suggest that RCIS personnel are less qualified or safe in assisting with fluoroscopy than other personnel. They cite old case reports of radiation skin injury from obsolete equipment without regard to the fact that modern fluoroscopy equipment is vastly safer. The last known radiation skin injury in my hospital’s cath lab happened over 20 years ago, and was entirely the result of equipment failure, having nothing to do with the training of the lab personnel. In addition, cardiology organizations, including the ACC, have gone to great lengths to better educate cardiologists in the safe use of radiation.
The Maryland Chapter of the American College of Cardiology pro- actively sought legislation in 2011 to deal with the inconsistent utilization of peer review and its proposals were adopted as an amendment to HB 1141 signed into law in May 2012. The chapter sought enhanced independent, external peer review.
The Maryland Chapter, at the invitation of the Maryland Health Care Commission, will be an integral part of the regulatory process to implement regulations and ongoing performance measures as a member of the newly established Clinical Advisory Group.
The legislation requires the state to appoint a Clinical Advisory Group to establish regulations to write requirements for peer or independent review of the placement of stents in heart patients in order to ensure consistency with guidelines developed by the American College of Cardiology and other cardiovascular organizations, the Maryland Chapter of the American College of Cardiology said today. Maryland is the first state in the nation to have such a law.
Maryland is the only state where specialists cannot own their own CT/MRI equipment nor perform certain studies. This confining law continues to be discussed at the legislative and regulatory levels. A court ruling held up the antiquated law but MDACC will continue to push to overturn the law to improve patient access and to allow our younger colleagues who are trained in these modalities to use them in Maryland if they meet proper certification. In 1993, the State of Maryland passed the Maryland Health Occupations Article known as the Self-Referral Law. The law prohibits referral within an office for CT and MR, except for a waiver granted exclusively to radiologists. Further, the law excludes any non-radiologist practice from hiring a radiologist to read scans or become a partner in an effort to circumvent the law. At the outset, not many physicians were concerned about this law as it did little to affect the day-to-day rhythm of their practice or their ability to provide quality care. In 2004 at the request of two members of the House of Delegates, the state’s Attorney General issued an opinion that fully upheld the law: "In our opinion, State law bars a physician in an orthopedic group practice from referring patients for tests on an MRI machine or CT scanner owned by that practice…The same analysis holds true for any other non-radiology medical practice." Shortly after this request the American College of Radiology (ACR) announced their nation-wide advocacy goal was to emulate the Maryland law in the other 49 states in order to protect the profession of radiology. Since 2004, American College of Cardiology (ACC) and the ACC state chapter network have defeated measures in almost every state.
SECOND HAND SMOKE
The effects of environmental tobacco smoke (ETS), also known as secondhand smoke, are significant. The scientific evidence on the health risks associated with exposure to secondhand smoke is clear, convincing and overwhelming. Secondhand smoke is a known cause of lung cancer, heart disease, low birth weights and chronic lung ailments, such as bronchitis and asthma (especially in children), as well as other health concerns.
The health risks related with secondhand smoke are staggering, and can now be proven to harm those in its presence. Secondhand smoke contains more than 4,000 toxins and cancer-causing chemicals, such as carbon monoxide, formaldehyde, arsenic, benzene and lead. In fact, concentrations of these toxins are higher in ETS than in mainstream smoke alone.