Legislature(2007 - 2008)CAPITOL 106
03/06/2007 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB148 | |
| HB136 | |
| HB159 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 148 | TELECONFERENCED | |
| *+ | HB 136 | TELECONFERENCED | |
| *+ | HB 159 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 136-DENTAL HYGIENISTS CHAIR WILSON announced that the next order of business would be HOUSE BILL NO. 136, "An Act relating to dental hygienists." 3:37:17 PM REPRESENTATIVE BILL STOLTZE, Alaska State Legislature, introduced HB 136, as prime sponsor. He explained that this bill serves two purposes: allowing dental hygienists to perform work, which they feel capable of undertaking; and creating a policy directive that will allow preventative oral health care in underserved areas of the state. CHAIR WILSON stated her intention to hear testimony on HB 136, and hold it in committee for further consideration. 3:40:22 PM BEN MULLIGAN, Staff to Representative Bill Stoltze, Alaska State Legislature, presented HB 136, on behalf of Representative Stoltze, prime sponsor, paraphrasing from the sponsor statement, which read as follows [original punctuation provided]: The provisions of House Bill 136 follow the expanded functions of dental hygienists in other states to improve access to preventative oral health care. Specifically, HB 136: 1. Allows a licensed dental hygienist to place "fillings" into a cavity prepared by a licensed dentist. 2. Authorizes a licensed dental hygienist to administer local anesthetic agents under the general supervision of a licensed dentist. 3. Permits a licensed dental hygienist to enter into a collaborative agreement with a licensed dentist in which the dentist authorizes the dental hygienist to perform certain duties stipulated under HB 136 without the supervision of the dentist. MR. MULLIGAN stated that currently a hygienist is allowed to administer local anesthetic agents under the indirect supervision of a licensed dentist. Additionally, a collaborative agreement could be entered into, which would allow a hygienist to perform the expanded functions, as listed in the bill. 3:41:19 PM CHAIR WILSON defined "direct supervision" as having the dentist in the same room, "indirect supervision" requires that the doctor be in the same building, and "general supervision" allows the hygienist to perform procedures under the auspices of a dentist. REPRESENTATIVE STOLTZE opined that HB 136 will sanction actions that already occur, to some degree, in dental offices. 3:43:05 PM DELISA CULPEPPER, Chief Operating Officer, Alaska Mental Health Trust Authority, Department of Revenue, stated departmental support for HB 136, stating that it will be "a good move," and will support efforts to provide dental care throughout the state. Dental hygienists were licensed to administer local anesthesia in 1976, she reported, and have been practicing the procedures with no adverse consequences. Placing fillings in a prepared [tooth] is something that "nation-wide, dental hygienists have done for years, and [it has] proven effective." The collaborative agreement will help to address dental care in rural Alaska and the hub communities. She also pointed out the significant support for this bill from various dental agencies. 3:44:57 PM SONIA HANDFORTH-KOME, Executive Director, Iliuliuk Health Clinic, stated support for HB 136, and she described the clinic as a 501(c)(3) non-profit community health center. Prior to the time when the clinic employed a fulltime dentist, the area was served by two dentists who traveled to the clinic on a part-time basis. The hygienist lived in the community but was unable to serve the "thousands" of patients, preventive or otherwise, because there was not a dentist in town. Inhibiting the hygienists from providing continuous, preventive care, does not keep pace with the mid-level provider concept that is common in the health care profession. She opined that the practice makes sense for non-profit, as well as for-profit, practitioners. This is a cost effective way to increase access to dental care, and to invoke a habit in people to visit a dental office. With regular dental care, diabetes and other health issues can be addressed. 3:48:29 PM VICKY HOFF, Alaska Dental Hygiene Association, stated support for HB 136, stressing the importance of the potential impact for increasing the hygienist's scope of practice. The hygienist will still be supervised by a dentist, but will have the ability to provide a local anesthetic and perform involved work. In the villages, she reported, if a deep cleaning requires a local anesthetic the hygienist is currently unable to be of service. 3:50:13 PM JENNIFER MCELROY, Dental Hygienist, Kenai Peninsula Dental Hygiene Association, stated support for HB 136, and expressed concern particularly for the senior group, and nursing homes. She reported that these homes, including ones located in community hubs, are not visited by dentists, although many of these seniors are unable to access a dental office. Having someone who can visit the senior's in group or nursing homes is important, and cost effective, she opined, and stressed that oral health is important for total health. 3:53:15 PM GAIL WALDEN, Dental Hygienist, Member, Alaska Dental Hygienist Association, stated support for HB 136, paraphrasing from prepared statement, which read as follows [original punctuation provided]: The needs of Alaskans are not being met by the current oral health care delivery system. Current statutes and regulations prevent dental hygienists from providing oral health care to the public in non-traditional settings. Dental hygienists receive a comprehensive education, are licensed, and regulated by the state, we have mandatory continuing education and CPR requirements. Ultimately, hygienists are not being utilized to their full potential. The Alaska Board of Dental Examiners, which licenses and regulates dentists and dental hygienists, met in February and voted to support HB 136. They concluded that the proposed statute changes are consistent with their vision to ensure that all Alaskans receive the best possible care. In addition to BODE, HB 136 has also received support from the Oral Health Coalition, Alaska Primary Care Association, and the AARP. Restorative Function License Endorsement Creates an efficient health care delivery system that increases the number of patients that can be seen in a limited amount of time. Procedures would be done under the direct supervision of a licensed dentist, and by hygienists that are educated and licensed to provide these additional services. The curriculum, examining, and licensing for restorative functions by dental hygienists has already been established in such states as Washington-just needs to be implemented in Alaska. Local Anesthesia Statutes since 1981, there has never been disciplinary action taken against hygienist for administration of local anesthesia under the current statutes. Dental Hygienists need and use local anesthesia to reduce stress and provide pain control in the treatment of moderate to advanced gum disease. Under general supervision a dentist is still required to diagnose and treatment plan the patient's needs: and whether or not a hygienist administers local anesthesia without the dentist in the practice remains at the discretion of the supervising dentist. There are 40 states where hygienists are licensed to administer local anesthesia, 2 of those states ID and OR can deliver local anesthesia under general supervision. Collaborative Agreement Has the potential to provide the greatest impact to Alaskan communities. Allows hygienists with experience to enter into a written agreement with a dentist that must be approved by the Board of Dental Examiners. The hygienist would be able to provide services listed under the agreement without supervision, and prior to the dentist seeing the patient. Would allow hygienists access to nursing homes and hospital facilities, homebound individuals, schools, Head-Start Programs, and rural areas where dentists are rarely available. Intended benefit is to reach individuals that are not receiving care and provide preventive services that not only increase oral health but general health and well being. In Conclusion All of these dental hygiene statute changes have been implemented in other states and have proven to be safe and effective. All statutes show our continued professional commitment to working collaboratively with dentists and providing services to the public by dental professionals that are formally educated and licensed by the State of Alaska. Dental hygienists cannot be self employed therefore, we cannot hold all liability. Dental hygienists can purchase liability, $77/yr with 2million per incident, 4 million aggregate. Dentists still have discretion over whether a hygienist delivers local anesthesia under general supervision-not in the office, do not schedule a procedure or person that requires LA. With a collaborative agreement, if a dentist isn't comfortable with taking on the liability of whatever procedure then don't include it in the agreement. 3:57:09 PM REPRESENTATIVE STOLTZE pointed out that these witnesses have offered supportive testimony, representing the various regions of the state. 3:57:46 PM DAVID LOGAN, Doctor of Dentistry, Chairman, Alaska Dental Society (ADS), stated opposition to HB 136, paraphrasing from a written statement, which read as follows [original punctuation provided]: If the goal is to increase services in underserved areas HB 136, as currently written, will at best marginally increase those services. The ADS feels, with some modifications, HB136 could be enhanced to meet those goals, however. I will address one part of the bill; also, that we feel should be removed for public safety. We support the addition of restorative functions but feel all qualified auxiliaries (both hygienists and assistants) should be allowed to perform those functions. We would encourage allowing the board set standards under regulation but do not object to requiring WREB [Western Regional Examining Board] restorative endorsement or equivalent. 18 other states allow all auxiliaries to perform restorative functions; only one state limits this to hygienists. We support coronal polishing and scaling by all auxiliaries under direct or indirect supervision. This is not currently a provision of HB136 and would greatly improve the delivery of dental services in currently underserved areas. We believe local anesthesia should remain under direct or indirect supervision A provision of the medical and dental professions is "Primum non nocere" - first do no harm - while the goal of increased delivery is laudable we are bound to follow this dictum. The level of training of hygienists is less than dentists for delivery of anesthetic, recognition of medical complications and delivery of emergency services. If the goal is to increase usage in underserved locations a caveat is these areas will more often than not be in remote locations and the farthest from medical help. To put it bluntly the procedures we are recommending be included in this bill are generally safe and even if performed incorrectly are easily remedied. Local anesthesia, if performed incorrectly, is one of the few ways in dentistry you can kill a patient. Regarding the collaborative agreement We do not feel development of a collaborative agreement, and increasing a level of bureaucracy, is necessary We feel all qualified auxiliaries, meeting criteria set by the board, should be able to provide the following in underserved areas under the general supervision of a dentist Coronal scaling and polishing Placement of temporary restorations Collection of records for diagnosing and treatment planning the patient Application of topical preventative agents These are safe procedures that do not require a dentist to render a diagnosis. The remaining provisions, removal of overhangs, root planning (non surgical therapy), use of chemotherapeutic agents beyond topical applications should be done only after a dentist has accessed, diagnosed and treatment planned the patient. Having care delivered under general supervision as opposed to the collaborative agreement will help insure continuation of patient care and treatment of the patient's greatest needs. What separates a dentist from the remainder of the dental team is the ability to diagnosis and treatment plan a patient. Dental procedures can be taught in a piece meal fashion, the ability to diagnosis and treatment plan, however, requires the ability to understand the entire oral structure and how it interrelates with the rest of the body. This is not so easily taught and one of the reasons dental school remains a difficult venture taking twice as long as hygiene school and the same length of time as medical school. The procedures we are recommending be included in HB136 should be in place for all qualified auxiliaries. This will allow increased delivery of dental services in underserved areas. The changes we are recommending, however, are changes that are safe for the public, procedures that are reversible in nature and will not harm the patients. For that reason we would encourage adopting those changes but removing the proposed change to allow local anesthesia under general supervision. 4:03:08 PM CHAIR WILSON inquired if the intent is to allow the dental assistant to perform the same procedures as the hygienist. DR. LOGAN explained that the line of demarcation is whether a procedure requires work "above" or "below" the gum line. Work above the gum line is considered a general skill in the dental field, and easily taught. However, to perform work below the gum line requires specialized training. In response to a question he stated that assistants are taught below gum line procedures by the dentist. 4:04:03 PM REPRESENTATIVE FAIRCLOUGH referring to previous testimony of the safe practice of anesthetic delivery by hygienists and asked if he is aware of any case where a hygienist has caused harm. DR. LOGAN said, "I do not specifically know of a case. No." He offered that there are national statistics that report adverse anesthetic delivery by both doctors and hygienists. REPRESENTATIVE FAIRCLOUGH inquired whose business license would "be on the line if there was a mishap" involving administration of an anesthetic, given the collaborative agreement requirement. DR. LOGAN interpreted the legislation to indicate joint responsibility, and liability. He clarified that this would be borne by the professional licenses of the dentist and the hygienist. 4:06:07 PM REPRESENTATIVE FAIRCLOUGH predicted that the subject would become mute, if the bill requires a collaborative agreement between a hygienist and dentist, and the dentists maintain opposition. DR. LOGAN stated hope that the legislature would alter the aspect of the bill that requires a collaborative agreement. He declined to speculate on whether dentists would choose to enter into a collaborative agreement. REPRESENTATIVE FAIRCLOUGH pointed out that the current language would provide the dentist a safeguard to evaluate a hygienists' abilities, and make a knowledgeable decision whether to enter into a collaborative oversight agreement, on an individual, case by case, basis. She expressed surprise that dentists would oppose such legislation. DR. LOGAN stressed that he would not personally enter into a collaborative agreement with anyone whom he does not directly employ. 4:08:14 PM REPRESENTATIVE CISSNA summarized the situation of dental care in the Bush. Comparing it to the level, and availability, of general health care provided by public health nurses, she said that dental care has been non-existent. It has been reported that patients have required Medivac service, due to dental neglect. She opined that, although dentists may be opposed to this bill, a moral responsibility exists for the sharing of knowledge, and professional assistance. She urged that perhaps the dental association could offer suggestions to solve this "embarrassment to the state." 4:11:07 PM REPRESENTATIVE ROSES stated support for HB 136, indicating his agreement with Representative Fairclough's point that, as it stands, the language allows a dentist the flexibility to enter into an agreement or not. Further, he stated accord with Representative Cissna's concern for providing dental care to the Bush communities. 4:12:44 PM REPRESENTATIVE FAIRCLOUGH moved to report HB 136 out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, HB 136 was reported out of the House Health, Education and Social Services Standing Committee.
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