TMB Should License Neurodiagnostic Technicians

Testimony by Kim Monday, MD, 

Texas Medical Association and Texas Neurological Society
CSHB 2978 

April 28, 2015

Madam Chair, members of the committee, I am Dr. Kim Monday. I am a practicing neurologist in Houston, and I am here representing the Texas Neurological Society and the Texas Medical Association in support of the Committee Substitute to House Bill 2978.

Our organizations want to thank Rep. Greg Bonnen for bringing forward this important issue. Without question, the field of neurodiagnostic testing is growing, and neurodiagnostic technicians (NDTs) are becoming more important members of the medical care team in our continual efforts to improve patient care.  

We believe NDT licensure is important for the Texas Legislature to consider for the following reasons. First, the information NDTs provide helps guide diagnosis and the course of treatment physicians like me prescribe to our patients. Second, the neurodiagnostic testing that NDTs perform involves the insertion of highly specialized medical instruments into the human body.  We believe the state of Texas has a public safety interest in understanding who these individuals are, and ensuring the training they receive is of the highest order and their technical skills comply with the highest safety standards. 

We support Committee Substitute to HB 2978 because it upholds our position, as follows. 

  • Licensure of NDTs should be attached to and subject to the Texas Medical Board rules. The Texas Medical Board oversees licensing and disciplinary functions for several other medically related professionals including physician assistants. Additionally, other legislation this session from the sunset process is moving other license types to the medical board. We believe the Texas Medical Board is the proper home for any licensure act for NDTs.

  • The Texas Medical Board is the best place to determine the level of physician supervision required for NDTs. In some instances, general supervision by a physician is appropriate. In other instances, particularly in an operating room setting, a physician’s direct supervision of will be appropriate. TMB is the correct regulatory board to determine these supervision standards.  

  • NDTs should not have independent access to patients. They should function solely under the supervision of physicians who ultimately bear the responsibility for their performance.  Again, NDTs insert complex medical instruments into the human body. In the interest of public safety, those actions need proper physician supervision. 

  • NDTs should not have independent use of needle electromyography (EMG) or other invasive testing procedures but perform them only when a physician explicitly orders their use. This is consistent with current law and court decisions. Texas courts have ruled that needle EMG can be performed ONLY by or under the supervision of a physician licensed to practice medicine.   

The members of TNS and TMA understand the new licensure requirements would be a shift in the current practice of many physicians and the NDTs they employ. TNS and TMA are sensitive to how these changes might disrupt access to current services. At the same time, we stand ready to work with anyone to provide commonsense solutions to those challenges.

Thank you for the opportunity to testify today. I am happy to answer any questions.  

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