Minnesota Society of Cytology

MSC position statement

Since approximately 2002, the Minnesota Society of Cytology has had a representative, Liz Miller (Fairview) to the Laboratory Coalition exploring licensure of laboratory professionals in the state of Minnesota. Once there was a larger state interest in licensure, MSC’s presence was expanded in 2005 to include Dan McKeon (Fairview), Shelley Semerad (Regions) and Heidi Sokolowski ( Mayo) and temporarily Lynnette Savaloja (Regions).

The coalition used as a starting point a draft of a bill that was a composite of bills approved by the ASCLS and ASCP. In this draft, cytotechnologists’ duties were limited to preparing, staining and reading GYN and NON-Gyn specimens,. No provisions were made for cytotechnologists to hold positions of laboratory leadership, education or research. Any advanced methodologies cytotechs are currently being trained in would not be in the scope of practice. With the ever changing role of molecular techniques in the laboratory, we need to be mindful about limiting the growth of all lab professionals in both the technical arena and areas of leadership. The MSC Licensure Committee drafted an acceptable scope of practice that would include the leadership positions stated above, and techniques such as FISH, Digital Image Analysis and other future testing methods.

With the advent of HPV testing and newer treatment guidelines, Papanicolau tests have declined, and with the advent of other new technologies and the HPV vaccines, may decline further. Cytotechs have training that lends it self to the needs of these and other techniques.
Therefore, the MSC Licensure Committee recommended to the MSC board that cytotechnologists be included in the bill “Licensure of Medical Laboratory Professionals”, have a protected scope of practice and have a seat on the regulatory board.

Quality should be the cornerstone at all labs in Minnesota. We maintain that we are already heavily regulated by CLIA and this would be another layer of legislation, but that not participating would represent a threat to our profession, limiting current practices and also future testing opportunities. While we are in the bill, our official stance is that we are neutral. We also maintain that state licensure doesn’t necessarily solve the issues of competency or patient safety.

To the Minnesota Laboratory Licensure Coalition. We have put together the action alert below. We need members of this coalition to get this information to members of their professional organization and to urge them to contact the committee members listed in the alert. In addition, I have copied this to Jillene Collins and Matt Zimmer for circulation to the memberships of ASCLS-MN and CLMA-MN. We need these contacts to occur this week at the committee hearings could occur as early as Monday, Feb 18 and definitely by Thursday, Feb 21. Our representatives need to hear from us NOW!

Rick Panning and Kathy Hansen, Licensure Coalition Co-chairs

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February 12, 2008

From the Minnesota Laboratory Licensure Coalition

(representing ASCLS-MN, CLMA-MN, ASCP, AGT, AACC-Midwest Section, AMT, MIMA, MnABB, MSC, MSH)

We need the support of all laboratory professionals
During the week of February 18-21, the laboratory licensure bill will have two hearings.

· Senate Health Committee for SF1830

· House Licensure Subcommittee for HF2109

We need you to contact, via email, the members of these two committees to voice your support for these bills. The opposition to the licensure legislation has raised the following points against the licensure legislation.

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Following are the points being raised against the legislation by the College of American Pathologists (CAP) and the Minnesota Society for pathology (MSP). As laboratory professionals, we want to take this opportunity to point out the inaccuracies in these statements

§ CAP and MSP say that licensure will exacerbate the current laboratory personnel workforce shortage in every area of the lab. Most states with laboratory personnel licensure have greater worker shortages. Moreover, positions that remain unfilled for long periods of time jeopardize quality and patient care.

§ While we acknowledge that there is a shortage, there is no evidence to show that licensure will make the shortage worse. In fact, we have government data from HRSA (Health Resources and Services Administration) which shows that states with licensure do NOT have a more severe shortage and that the growth of the workforce is actually greater in states with licensure of associate and bachelors degree personnel. Licensure states have 114.7 lab professionals per 100,000 population compared to 101.9 in unlicensed states. In addition, the growth rate laboratory professional employment is 20% in licensed states and 15% in unlicensed states

§ CAP and MSP say that licensure will complicate the compliance of Minnesota’s clinical laboratories with the federal Clinical Laboratory Improvement Amendments (CLIA) implemented in 1992. Under CLIA, laboratory directors are responsible for qualifying and supervising laboratory personnel.

§ The bill, as written, builds on the requirements as defined in CLIA, and in the area of testing personnel, requirements above CLIA’s minimal personnel standards. The bill addresses requirements for entry level professionals but does NOT change the requirements for laboratory directors, technical supervisors or technical consultants. Licensure builds on CLIA. If hospital laboratories operated at the level of the CLIA, personnel standards would be lowered significantly.

§ CAP and MSP claims that licensure will greatly complicate and encumber the administration of the laboratory by pathologists and laboratory directors by circumscribing scope of practice for all laboratory personnel, making administration of the laboratory a greater challenge.

§ This bill, supported by the Clinical Laboratory Management Association and the American Society for Clinical Pathology (representing clinical laboratory professionals and medical directors) sets reasonable requirements that all future laboratory professionals meet the necessary education, experience and certification that is needed for high quality and patient safety. Studies in the Journal of the American Medical Association (JAMA) have shown that more stringent personnel requirements result in lower rates of errors. At this time, the qualifications which become requirements for licensure in this bill are purely voluntary and at the discretion of each institution. In times of a personnel shortage, having staff meet these requirements is even more important.

§ CAP and MSP claim that licensure may lead to diversion of laboratory work to out-of-state laboratories that are not encumbered by the regulatory requirements entailed with licensure regulations, thereby exacerbating fragmentation of patient care and increasing lag time of diagnosis and treatment of patients.

§ This assumption is totally without substantiation. North Dakota has had personnel licensure since 1991 and has not seen this occur. At this time, more and more states are considering personnel licensure to assure that the laboratory professionals performing important patient work will meet the necessary entry level requirements,

§ CAP and MSP say will negatively impact the growing area of molecular technology due to workforce shortage and restriction of qualified individuals who may be considered experts in other parts the country, but who may lack the requisite licensure qualification.

§ As written the licensure bill provides certification in molecular biology or molecular pathology by ASCP-BOR or NCA as one option available to become eligible to attain a license. The bill DOES NOT limit performance of molecular testing to professionals with this certification. In fact, molecular testing is included in the scope of practice of Medical Technologists/Clinical Laboratory Scientists, Medical/Clinical Laboratory Technicians, Cytotechnologists and Histology technicians/histotechnologists

The opposition from CAP and MSP has made many unsubstantiated claims related to what might happen if licensure requirement are enacted. We need laboratory professionals to point out these unsubstantiated claims and to voice their support for licensure.

Following is a list of the members of the Senate Health Committee and the House Licensure Subcommittee. We would ask you to contact these legislators, especially if you live in their district (in parentheses behind their name),

House Licensing Subcommittee

Cy Thao (Chair) (65A) rep.cy.thao@house.mn

Jim Abeler(48B) rep.jim.abeler@house.mn

Julie Bunn (56A) rep.julie.bunn@house.mn

Brad Finstad (21B) rep.brad.finstad@house.mn

Patti Fritz (26B) rep.patti.fritz@house.mn

Rod Hamilton (22B) rep.rod.hamilton@house.mn

Erin Murphy (64A) rep.erin.murphy@house.mn

Kim Norton (29B) rep.kim.norton@house.mn

Maria Ruud (42A) rep.maria.ruud@house.mn

Senate Health Committee

John Marty (chair) (54) sen.john.marty@senate.mn