Ohio Senate Health Committee - 3-25-2026

We'll get started. I will make note for the record, my aide did not give me a gavel. We'll start the committee. Clerk, will you take the roll?

Here.

Here. Having a quorum, we'll act as a committee. I'll ask the members to look at the minutes from the last meeting and see if there's any additions or corrections. Seeing none, the minutes will be a stand. There's a number of governor's appointments. The chair will recognize Senator Johnson for a motion.

All right. Is there any questions before we take the vote? Seeing none, clerk, will you take the roll?

Yes.

Ranking Member Liston. Senator Ingram. Yes. Senator Manchester. Yes. Senator Rogner. Yes. Senator Romachuk.

Thank you, Mr. Chairman. I move that we favorably report Senate Bill 320 to the Senate Committee on Rules and Referent.

Senator Huffman?

Vice Chair Johnson? Yes.

All right. Make sure everybody signs the rolls, and that will be reported to rules in reference. And that will end the fourth hearing. Next up, the fourth hearing on House Bill 377 regarding the use of light-based medical devices for hair removal. There is no testimony. What is the pleasure of the committee? The chair recognizes Senator Johnson for a motion.

Is there any questions or discussion before we vote? Seeing none, the clerk will you take the roll?

Yes.

Ranking Member Liston? Senator Ingram? Yes. Senator Manchester? Yes. Senator Rogner? Yes. Senator Romachuk?

Thank you. Chair Huffman, Vice Chair Johnson, Ranking Member Liston, and members of the Senate Health Committee, my name is Todd Baker, and I'm here today on behalf of the Ohio Optimological Society, a statewide professional organization of eye physicians and surgeons. With me is Monica Hickel, who is representing the Ohio State Medical Association, the state's oldest and largest professional organization representing Ohio physicians, residents, and medical students. Thank you for the opportunity to provide joint testimony today, expressing our continued opposition to substitute Senate Bill 36 regarding the scope of practice of optometrists. OOS and OSMA remain committed to improving Ohio's eye health care system, but the amended language in the sub-bill does not resolve our fundamental concerns regarding surgical training, patient safety, and appropriate oversight. Additionally, several of the new detailed requirements in the sub-bill were ones that the proponents had previously testified were already components of the 32-hour training course required in the original version of the bill. Thus, the sub-bill does not establish many new requirements, but instead codifies what was previously asserted to already exist. Surgical competence is not achieved through limited exposure to a procedure three, four, or even five times as required in Sub-Bill 36. It is developed through four years of medical school, followed by four years of intense ophthalmology residency training. During residency, ophthalmologists repeatedly perform hundreds of laser and surgical procedures over several years under supervision of multiple faculty members. They are evaluated longitudinally through structured assessments conducted by program directors and clinical competency committees, not based on raw case numbers performed over a few days and evaluated by a single instructor as proposed in the sub-bill. Recent ophthalmology residency graduates report averages exceeding 100 laser procedures during training, often undercounting total exposure due to assisting and observational experiences. These numbers don't include the hundreds of other types of surgeries being done. The depth and breadth of supervised surgical education cannot be replicated in a 32-hour course. Equally important, medical school and residency training developed a clinical judgment necessary to determine when not to operate, a decision that is often as critical as performing the surgery itself. Additionally, the sub-bill still fails to acknowledge a foundational requirement of accredited surgical residency. and that is graduation from a medical school. Medical education provides comprehensive training in systemic disease, pharmacology, physiology, and whole patient management. Surgical decision-making requires understanding how ocular conditions intersect with diabetes, hypertension, autoimmune disease, and other systemic factors. Optometric education does not provide equivalent medical training in these areas. The distinction is central to patient safety. We have been clear in discussions related to the sub-bill and previous versions. We believe there is a pathway for optometrists to do eye surgery in Ohio that does not require legislative action by this committee or any policymaker. Optometrists that want to do eye surgery can apply to medical school and then subsequently apply and be selected for ophthalmology residency. We know that pathway is possible because we have seen several examples of it working in our state. In fact, the former chairman of the Ohio State University Department of Ophthalmology was originally trained as an optometrist. And then he went to medical school and he did his residency and became an ophthalmologist doing surgery on numerous Ohioans. The sub bill, like its predecessor, places authority for surgical certification with the Vision Professions Board, which lacks medical doctor representation and excludes any oversight by the state medical board. Surgical practice involves whole patient medical considerations that extend beyond procedures isolated to the eye. Oversight of surgery by a board without a physician representation raises significant concerns about establishing and maintaining appropriate medical surgical standards. Recent experiences in other states, including Kentucky, where expanded scope resulted in serious patient harm, underscore the real-world risks of insignificant or insufficient training and oversight. While the sub-bill excludes injections directly into the globe of the eye, it continues to authorize other types of injections, including those into the eyelid. The underlying deficiencies remain unchanged. limited procedural exposure, no medical school prerequisite, inadequate regulatory oversight. These concerns apply equally to injection authority as they do to surgical authority. The sub-bill limits procedures performed by optometrists to patients 18 and older, but this does not address the core concerns at hand with this legislation. For example, YAG laser capsulotomy procedures overwhelmingly involve patients over the age of 60 following cataract surgery. The exclusion of pediatric patients does not resolve the training or oversight deficiencies. In conclusion, like previous versions, we believe the sub-bill is a solution looking for a problem. We remain committed to strengthening Ohio's vision health system through collaborative patient solutions For example just last week the Ohio Department of Health reached out to our organization the OOS and the Ohio Optometric Association to discuss innovative and collaborative ways for the professions to encourage school districts with students in need to register for the Ohio C program. We look forward to continuing to contribute to the advancement of policies that expand access to high-quality care like this program. Thank you again for providing us with the opportunity to share our collective comments and concerns with the sub bill. Monica and I would be happy to answer any questions the committee may have. Thank you.

Thank you Mr. Chair and thank you for your presentation. So there's nothing in in the bill that your concern makes sense, even the sub-bill?

Okay. Follow if you want. No, I'm just trying to weigh both sides of this because it's very, very controversial as far as I'm concerned. And we've been kicking this for a couple of GAs now, so I just want to be clear about, is it overreaching? Do they actually need the training? Or is Ohio State, with the introduction of the bill through Senator Serino and Senator Lang, just, we want to do more? But then again, you say the health department reached out to you regarding the Ohio Sea. What are we doing? I'm just still confused with what we need to do and what's wrong with how much the optometry folks want to do and what the ophthalmologist folks need to do.

If I may.

I guess my difficulty is that it's not just 36 hours. It's the claim that there's all this other training that has taken place, and the 36 hours or 32 hours, whatever it is, is on top of it. So what you're saying is even with that, there's still those limited things that they still should not be able to do.

Edon?

I think so, Chairman. So I think you're saying is the person who's had some experience in a state that currently allows for some of the procedures that are being contemplated here, allow them to come to Ohio and get a license in Ohio and do the procedure in the same manner. This bill, my understanding of this bill and the way that it's written, puts that authority with the Vision Professional Board. So if the Vision Professional Board determines that that person is capable of doing it, then they would be able to do it if they've met the criteria that has been established. So there is that alternative pathway. Again, what I would come back to is the concern related to the regulatory body that's in charge of certifying that process, which is not made up of any MDs or DOs or anybody that has surgical experience. Okay.

Thank you.

Good morning. My name is Allison Stokes. This is my first time testifying in any sort of hearing. I've enjoyed kind of learning about this process a little bit as I've been going through this, so I appreciate your time this morning. Chair Huffman, Vice Chair Johnson, Ranking Member Liston, and members of the Senate Health Committee. Thank you for the opportunity to provide testimony today. My name is Allison Stokes, and I serve as Junior Chair of the Ohio Society of Radiologic Technologists Board of Directors. The OSRT represents Ohio's medical imaging professionals and is committed to advancing practice standards to enhance patient care. The OSRT strongly opposes Senate Bill 324 because it directly impacts patient safety, diagnostic accuracy, and the quality of medical imaging in Ohio. Radiographic imaging is simply not just pressing a button. It requires knowledge of radiation physics, anatomy and pathology, radiobiology, radiation protection, and real-time evaluation of image quality and patient safety. These are all essential competencies developed through 2,000-plus combined didactic and clinical hours hours for registered radiologic technologists. Senate Bill 324 defines a general x machine operator or GXMO as someone who does not to any significant degree determine procedure positioning or the dosage of radiation However, every radiographic exam requires exactly those decisions. This creates a direct contradiction within the bill. The GXMO rule was originally designed for low acuity outpatient environments such as chiropractic or podiatry offices where imaging is repetitive, limited in scope, and directly supervised by a provider with imaging-related education and clinical competency. Urgent care settings are fundamentally different. They involve a wide range of patients with acute to chronic illnesses, pediatric and geriatric populations, and individuals who may require exam modifications to obtain a quality image due to a more severe injury such as a fracture. Medical imaging and urgent care setting can involve any body part at any time on any patient, making it inherently more complex and demanding a higher level of education, critical thinking, and adaptability. This is not an equivalent clinical environment intended for a GXMO. Ohio has over 650 GXMOs and more than 14,000 registered radiologic technologists, which is roughly a 1 to 20 ratio. This bill does not expand access to care. It replaces highly competent professionals with lower cost labor. Senate Bill 324 has been framed as a solution to improve access to quality care in rural communities. The OSRT strongly supports improving access to care. However, access must be paired with quality and safety. How does lowering education and supervision requirements result in higher quality care? Expanding access to lower standards does not improve care. Instead, it creates a two-tiered system in which patients in certain settings receive a lower standard for diagnostic imaging. Patients in rural and underserved communities deserve the same level of care, the same diagnostic accuracy, and the same protection from unnecessary radiation as patients in urban hospital systems. Lowering education requirements, allowing individuals without competency to perform imaging, and reducing supervision requirements does not increase quality. It increases risk. If the goal is truly to improve access to quality care, then the solution is not to reduce education and competency, but to ensure that qualified imaging professionals are available and supported in all communities. GXMO didactic education and clinical training is extremely limited, often ranging from 16 to 60 hours of didactic instruction. Clinical requirements may be completed without real clinical patient interactions. Some GXMOs may begin their practice without ever positioning a real patient. In contrast, radiologic technologists complete 2,000-plus combined didactic and clinical hours and are required to demonstrate competency in specific exams for procedures as defined by the American Registry of Radiologic Technologists. If GXMOs can complete training without real patient experience, then urgent care centers now become the training environment, placing patients at risk. Much of the proponent testimony discussed how modern technology has virtually eliminated re-exposing patients due to incorrectly administered radiation. This is simply not true. In digital imaging, improper techniques can still produce an image that appears acceptable while delivering excessive radiation exposure. It does not eliminate errors, but rather it hides them. This leads to a well-documented phenomenon known as dose creep. Adjusting brightness on a screen does not improve image quality. Modern imaging technology does not replace training. It requires it. Radiographic techniques must be tailored to each patient. Children are not just small adults. They require lower radiation doses and specialized expertise in pediatric anatomy and positioning that cannot be applied from adult imaging practices. Larger patients require higher radiographic techniques to increase the penetration, the radiation, to obtain diagnostic quality image without quantum model. These are not skills taught in GXMO training. Senate Bill 324 would allow GXMO supervision by nurse practitioners and physician assistants. These individuals, while highly trained in patient care and specialty areas, do not receive formal education or clinical training in radiographic positioning, radiation dose optimization, radiation protection, or image analysis. This means supervision would be based on title and not imaging competency. The bill further states that direct supervision does not require the practitioner to observe each radiologic procedure performed, removing real-time oversight. Section 4773.06C introduces a critical loophole. Under this provision, a GXMO who is also a nurse practitioner would not be required to be supervised at all while performing radiologic procedures. This creates a system where individuals without sufficient imaging education and clinical training are performing imaging without supervision from a radiologic expert. Supervision and medical imaging must be based on competency, not on credentials that do not include imaging education. A responsible path forward exists by aligning GXMO education and training with the American Society of Radiologic Technologists' limited X-ray machine operator standards, including structured education and real patient competency. The Ohio Department of Health would continue state oversight for accreditation of educational programs and develop and administer a comprehensive examination at the state level. In closing, Senate Bill 324 allows individuals who are not comprehensively educated to perform diagnostic imaging without appropriate supervision. When Ohio already has a strong pool of well-qualified imaging professionals, lowering educational requirements does not expand access to care. It lowers the standard of care. The Ohio Society of Radiologic Technologists respectfully asked this committee to oppose Senate Bill 324. Thank you, Chair Huffman, Vice Chair Johnson, Ranking Member Liston, and members of the committee for your time and your consideration. I would be happy to answer any questions.

Yes, sir. That is correct. And they're trained and licensed in the state of Ohio and trained on radiation, but not to the same level as an RT. That is correct. It is very limited education. They are not trained on how to adjust technical settings in a clinical environment. That is related to patient size, their pathology, their condition. Okay.

They are utilized in an urgent care setting now when that was not their intention. The intention in 1995 when the GXMO was created was to practice within podiatry offices and chiropractic offices where those practitioners, the actual chiropractor, is trained on how to do all of the x-rays and how to look at those x-rays and how to adjust the technique. They had sufficient training to directly supervise those GXMOs who were taking those images to facilitate care in those specific offices. What is happening now is those GXMOs, they've just kind of, they've been there, right? And people are starting to really push them into directions that they're not really qualified for. And the training associated with that is apparent. I did provide you all with a side-by-side comparison of GXMO, an LXMO, and a radiologic technologist as far as training is concerned. The idea that a GXMO in urgent care is now going to possibly be supervised by an NP or PA who also does not have that designated training and any sort of technical manipulation. They don't know how to adjust for patient condition. Doing a fracture on a six-year-old who has an obvious deformity, I'm not going to go like this with them. I'm going to think outside of the box and image them in different ways so I don't have to have them move a fractured arm and make them cry. Those GXMOs don't know how to do that. The nurse practitioners, again, they are very well educated. They have a lot of clinical training. but it not specialized to what we do in imaging Thank you So going back to supervision and radiation

I think if they are put into that supervisory role, that additional training is necessary. That is just my personal opinion, not the opinion of the OSRT.

There is different verbiage in there. at the state level for what is considered direct supervision, what is general supervision, and what is personal supervision. Direct supervision per state requirements is that individual is within the department, within that building, and readily available. That is considered direct supervision. So we are not requiring in this bill to have those NPs and those PAs in the room with that direct supervision, but real-time image evaluation is kind of important. So deciding whether it's a quality image or if you have to take a repeat exposure is part of that image evaluation. So having that understanding is important.

Eli Fax from Leading Age Ohio.

My name is Eli Faze and I serve as Public Policy Director for LeadingAge Ohio, which represents mission-driven nonprofit providers of aging services across the state. Our members provide a continuum of care to older Ohioans, including nursing facilities, assisted living communities, and other residential care settings. Thank you for the opportunity to testify as interested party on substitute Senate Bill 154. So you have my written comments. I know it says Susan Wallace on them, but she was unable to make it today. So I'm going to touch on just a few of our points here, which are basically the privacy and dignity of residents, HIPAA compliance, and bandwidth issues. So LeadingAge Ohio understands and appreciates the intent behind Esther's Law, which was enacted in 2022 to provide residents and families additional transparency and reassurance regarding the care being delivered in long-term care settings. We worked with the sponsors of that original bill and supported our members throughout implementation with sample policies, forms, and other tools to ensure compliance. One of our concerns with the current draft are related to the secure transmission and storage of protected health information. First, we've learned that the information contained in the feed, whether it's patient-identifying information, data related to the resident's health status or care, or private images of the resident, is not considered personal health information if the resident is the one filming the information for their use alone. However, in shared rooms, which remain common in many long-term care environments, it creates additional challenges. Cameras or audio recording devices may capture conversations or care activities involving another resident whose protected health information could be recorded without their knowledge or consent. For this reason, we recommend the bill be amended to require not only the written consent of any roommate before any electronic monitoring device may be used, but also an authorization to disclose protected health information to those individuals who will be accessing the device's recording to protect providers from HIPAA-related litigation. As the technology evolves, particularly with devices capable of audio recording or two-way communication, it's important that any monitoring authorized under statute operate in a manner that protects resident privacy and complies with applicable federal and state privacy laws governing protected health information. Second, the bill's provision related to Internet access may create additional operational challenges for providers. As currently drafted, the legislation appears to require facilities to provide Internet access for monitoring devices if it is available within the facility while limiting the ability of the providers to recover certain costs associated with expanding or upgrading their Internet infrastructure. In practice, many of the monitoring devices currently used are consumer-grade, internet-connected cameras that rely on continuous video streaming. When multiple devices operate within a single building, they can significantly increase bandwidth demands and affect reliability of internet services used by residents, families, and staff throughout the facility.

Any questions? Yes.

Sure, of course.

Mr. Sherry, and that's one of the concerns that we have, right? So I think that with, you know, informed consent and making sure that we have the consent of those shared rooms with roommates, and I don't, you know, I'm not sure what that would look like. That's something that we would have to work on and do a legal analysis as far as HIPAA compliance. But those are sort of the questions, even as Esther's Law, you know, in practice today in nursing facilities and kind of opening it up to other care settings that, you know, since we're revisiting the statute with Senate Bill 154, we think it's time to kind of look at those to make sure that everything's squared away.

Mr. Chair, you know, I think it's like with a lot of things that get passed. Once it's operationalized for a few years, you know, new concerns come up, new questions come up. You see where providers might have questions or needs that need to be addressed that maybe weren't considered fully when the statute was originally passed. So, again, we see this as an opportunity to kind of close some of those loopholes.