HD45 - Review of Need to Regulate Cytotechnologists and Cytotechnicians in Virginia

  • Published: 1989
  • Author: Department of Health Regulatory Boards
  • Enabling Authority: House Joint Resolution 83 (Regular Session, 1988)

Executive Summary:
House Joint Resolution Number 83 of the 1988 Legislative Session of the Virginia General Assembly requested the Board of Health Professions (formerly the Council on Health Regulatory Boards) to study the regulation of cytotechnicians and to report its findings to the 1989 General Assembly. The Resolution called especially for the Board to "examine the job conditions of cytotechnicians in Virginia, the workload, and how such technicians are paid as well as the potential for harm that shoddy work or lack of expertise may cause."

The Resolution presented the following assertions in support of the request:

• cytotechnologists are not regulated in Virginia;
• cytotechnologists perform analyses of Pap smears for women, the test used to detect cervical cancer;
• according to journalistic reports, low-rate, high-volume analyses of Pap smears is a lucrative business, operating with little regulation;
• the laboratory industry depends on overworked cytotechnicians by paying on the basis of piece work requiring a large volume of analyses in given time periods;
• the appropriate training for cytotechnicians is a college degree with specific additional training, yet many technicians have little or no training;
• the capability to differentiate types of cells and to identify abnormalities declines as an individual becomes fatigued;
• many cytotechnicians hold down more than one position and complete analyses on an assembly line basis;
• there are recent increases in the incidence of death from cervical cancer among young women, despite the reduction of these deaths due to the use of the Pap smear for early detection;
• the error rate among cytotechnicians is at least ten percent although most women believe that a negative Pap result assures them that they do not have cancer; and
• many professions and occupations are regulated in Virginia that do not have the responsibilities or potential for causing harm as do cytotechnologists.

House Joint Resolution No. 83 is closely related to the broader Senate Joint Resolution No. 62, also approved by the 1988 General Assembly. SJR 62 (appended) established a Joint Legislative Subcommittee charged to:

• examine the preparation and qualifications of medical technologists and cytotechnologists;
• review clinical laboratory testing including that performed in private physicians' offices;
• evaluate the need to regulate clinical laboratories and the appropriate supervision of medical directors; and
• evaluate the need for requisite standards for obtaining and preparing specimens.

To avoid duplication of effort and the possibility of conflicting conclusions, the Board of Health Professions determined at the outset to monitor closely the work of the Joint Legislative Subcommittee, chaired by Delegate Shirley F. Cooper, established to implement SJR 62. It was also agreed that the intent of HJR 83 was that the Board study the need to regulate both cytotechnologists and cytotechnicians.

As the work of the Board and of the Joint Legislative Subcommittee progressed it became ever more apparent that many of the problems cited in HJR 83 were being addressed by the Subcommittee and by newly enacted federal legislation intended to correct problems within the medical laboratory industry. Moreover, it became evident that, in light of these and other developments, recommendation of a specific, inflexible posture relative to the regulation of cytotechnologists or cytotechnicians might prove premature or counterproductive at this time.

It was determined that the Board of Health Professions' review would conclude with a report presenting basic information on (1) the professions of cytotechnology and cytotechnicianry (and related medical laboratory occupations) and (2) the nature of occupational regulation and its utility as a mechanism for the improvement of work conditions within the laboratory industry and of the quality of laboratory services.

The Board of Health Professions believes that any ultimate or final recommendation related to the regulation of laboratory personnel should be deferred until the effects of major reforms in the laboratory industry can be ascertained. The Joint Legislative Subcommittee Studying Clinical Laboratory Testing concurs in this view.

This interim report is organized as follows. First, an overview of allied health personnel who function in the clinical laboratory industry is provided, followed by a review of occupational regulation as an approach to quality control. The criteria used by the Board of Health Professions to evaluate the need to regulate cytotechnologists and cytotechnicians are then applied, and the report concludes with findings and recommendations that may be reliably proffered at this time.